Abstract
We report a 40-year-old female patient with medication-overuse headache (MOH) following triptan abuse. She was diagnosed as having migraine without aura at the age of 16. At the age of 39, she started taking sumatriptan orally in addition to a calcium antagonist to treat her headache. Initially, the sumatriptan was effective against her migraine attacks. However, the frequency of sumatriptan intake gradually increased because she may have had tension-type headache as well. From the time she started taking 100mg of sumatriptan daily, and headache was persistent, but different from her previous headache. Thus, she started taking 300mg of sumatriptan daily based on her own judgment. We diagnosed her MOH following sumatriptan overuse. We immediately discontinued the sumatriptan, replacing it with long-acting NSAIDs and drugs against tension-type headache. Although severe withdrawal headache appeared after sumatriptan discontinuation, there was remission of her headache within a week. The experience obtained by treating this patient suggests the following. First, we should suspect MOH when treating a patient with a history of triptan overuse if the characteristics of the headache have changed. Second, MOH treatment is difficult because the patient must be aware that in the initial few days there will be a deterioration of the headache. Finally, it is important to control the pain and associated symptoms during the withdrawal headache and to establish a prophylactic treatment. Moreover, we must educate patients.
