Abstract
A 31-year-old man with a 10-year history of migraine was referred to our hospital with a treatment-resistant chronic headache. He complained of a gradually worsening headache, with sharp pain appearing for several hours, as if having just eaten ice-cream. Five years previously, his headaches began to persist throughout the day, with no complete remission. With extremely severe headaches, he sometimes stayed in bed for a few days. He had been prescribed analgesic SG combination granules (an isopropylantipyrine, acetaminophen, allylisopropylacetylurea, and caffeine combination) 7 years previously, which he had taken 2 to 4 times daily for the past 5 years. Using International Classification of Headache Disorders diagnostic criteria (3rd Edition), he was diagnosed with a medication overuse headache (MOH) (8.2.5 Combination-analgesic- overuse headache). One month later, following complete discontinuation of his analgesic medication, his headaches had improved significantly (numeric rating scale, 1-2/10). MOHs can be overlooked as refractory headaches. Physicians should be aware that patients with MOHs may present with non-specific headache symptoms, including cold stimulus-like headaches, and an active headache and medication history should be taken to ensure accurate diagnosis and effective treatment, such as discontinuation of the causative agents.
