Consider the following in the diagnosis of medication-overuse headache: Consider a diagnosis of medication overuse headache in patients with headache on ≥ 15 d/mo and assess patients for possible medication overuse (use of triptans, ergots, combination analgesics, or opioid-containing medications on ≥ 10 d/mo, or use of acetaminophen or NSAIDs on ≥ 15 d/mo) When medication-overuse headache is suspected, the patient should also be evaluated for the presence of the following: -psychiatric comorbidities (depression and anxiety); these might need to be considered in planning an overall treatment strategy -psychological and physical drug dependence -use of inappropriate coping strategies. Rather than relying on medication as a main coping strategy, patients with suspected medication overuse might benefit from training in and development of more adaptive self-management strategies (eg, identification and management of controllable headache triggers, relaxation exercises, effective stress management skills, and activity pacing) Headache diaries that record acute medication intake are important in the prevention and treatment of medication-overuse headache

NSAID—nonsteroidal anti-inflammatory drug.

Based on the Scottish Intercollegiate Guidelines Network guideline²⁹ and expert opinion of the Guideline Development Group.