Medication-overuse headache: when the treatment becomes the pattern

Acute migraine medication taken frequently enough can itself become part of what keeps headaches going. It is a recognised diagnosis, not a judgement.

The International Classification of Headache Disorders (ICHD-3) classifies medication-overuse headache under specific, countable thresholds: regular use for more than three months of ergotamines, triptans, opioids or combination analgesics on ten or more days per month, or of simple analgesics such as paracetamol, aspirin or other NSAIDs on fifteen or more days per month.

Why it is easy to cross without noticing

The thresholds are counted per month, but the decision to take something is made one attack at a time, and each of those decisions is reasonable on its own. Nobody experiences ten separate days as a pattern. Over-the-counter medicines compound this: they are not tracked by a pharmacy record, they get taken for other kinds of pain, and combination products can contain more than people register.

The result is that the count is genuinely hard to know from memory — and the count is the whole diagnostic criterion.

Why this is the strongest case for logging treatments

Of everything worth recording about migraine, treatment days may be the most concretely useful, because the number maps onto a defined clinical threshold. Recording what you took and when produces an answer to "how many days last month" that is a fact rather than an estimate.

Mira records treatments against each attack, including whether they helped, and surfaces them in the doctor report. Relief information matters alongside the count: escalating use with falling relief is a specific thing to raise.

What not to do with this

Do not stop or change a prescribed medication because of an article. Withdrawal can temporarily worsen headache, and how it is managed depends on which medication is involved — that is a plan to make with a clinician. What is useful is arriving with the actual numbers.

See also what to bring to a neurology appointment.

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This article describes general patterns from published clinical sources. It is not medical advice, diagnosis, or a treatment recommendation, and Mira is not a medical device. If your headaches are new, changing, or affecting your daily life, talk with a qualified clinician. This article — and Mira itself — exists to make that conversation more concrete, not to replace it.