How do you manage patients with chronic migraine as well as medication overuse headaches?

I agree with Dr. @Dr. First Last about the treatment for chronic migraine and MOH for patients on opiates and/or barbiturates. If they are taking frequent opiates, I prefer to have a pain management doctor detoxify them. In the past, I slowly decreased their medication while giving them long-acting ...

Updates to this answer 4/3/2026: anti-CGRP medications are an excellent way to avoid rebound headaches and should be used as early as possible. The challenge in doing this is that some insurances still require trying triptans first, but this is changing over the past year, where great strides have b...

The worst to control in these scenarios are the patients who are on chronic opioids for chronic intractable other pain, not headaches. I usually go through the standard first-line meds and at times, CGRP antagonists alone with no luck. I have a few on combination therapy of Botox, topiramate, and a ...

I'm in pain management and work with our headache specialists. I spend a lot of my time having conversations with patients about opioid wean and the most important thing is to get patients on board. A process of trust, as they have to understand things may feel "worse" (when they initially get off o...

Just to add to all traditional treatments.

Most of the time, neck abnormality is a trigger so include instructions for better neck posture, neck stretching, and release technique for a more successful treatment.

I educate patients about the pitfalls of medication overuse headaches and try my best to transition them to a CGRP inhibitor. However, challenges arise when patients require opiates for concurrent arthritis and face difficulties tapering off these medications with their pain specialists. If MOH stem...