Medication-overuse headache: A pharmacovigilance study in France - 08/03/24

Doi : 10.1016/j.therap.2024.02.001

Mohamad Houssam Al Balkhi ^a,⁎ , Julien Moragny ^a, Solène M. Laville ^a,^b, Sophie Liabeuf ^a,^b, Pauline-Eva Pecquet ^a, Benjamin Batteux ^a, Cosette Le Souder ^c, Florelle Bellet ^d, Valérie Gras ^a, Kamel Masmoudi ^a
^a Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, 80054 Amiens, France
^b Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, 80054 Amiens, France
^c Pharmacovigilance Center, Department of Medical Pharmacology and Toxicology, Montpellier University Medical Center, 34295 Montpellier, France
^d Pharmacovigilance Center, Saint-Étienne University Medical Center, 42055 Saint-Étienne, France

^⁎Corresponding author. Clinical Pharmacology Department, CHU d’Amiens-Picardie, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex, France.Clinical Pharmacology Department, CHU d’Amiens-Picardierond-point du Professeur-Christian-CabrolAmiens cedex80054France

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Summary

Background

Overusing medication for primary headaches or other medical conditions can lead to dependency and medication-overuse headache (MOH) as an adverse drug reaction (ADR).

Objectives

To analyse reports of ADRs associated with MOH recorded in the French national pharmacovigilance database (FPVD).

Methods

This retrospective study selected all MOH cases reported in the FPVD from January 2000 to June 2023. A search of the High-Level Group Term “headache” was performed for drugs classified under ATC codes for the musculoskeletal and nervous systems. Specific keywords were searched in report narratives to further reduce their number. Voluntary intoxication reports were excluded. Only MOH cases according to the International Classification of Headache Disorders or with a medical diagnosis of MOH were considered.

Results

Among the 2674 reports associated with the HLGT “headache”, for 649 ATC drug codes, only 234 reports correspond to MOH, primarily notified by physicians. The median age was 45 years (IQR: 32–56), with 74.4% females and approximately 61.0% having pre-existing primary headaches. In all, 53.4% of the reports were classified as serious. Among patients, 84.2% had an isolated “headache” as the ADR. One drug was suspected in 47.4% of cases, two drugs in 29.1%, and three or more in 23.5%. In total, 473 suspected drugs, corresponding to 104 active ingredients, were involved, including analgesics (63.0%), in particular, acetaminophen-containing drugs, opioids, triptans and ergots, and non-steroidal anti-inflammatory drugs (12.7%). Antiepileptics and psycholeptics were found in 6.6% and 6.1% of cases, respectively. Drug withdrawal was successful in 84.6% of drug-discontinuation cases. Warnings about MOH are mentioned in the summary of product characteristics (SmPCs) for triptans, ergots, and certain acetaminophen-containing drugs, but not other drug classes.

Conclusions

Certain drug classes show a high reporting rate of MOH and caution should be exercised when prescribing these drugs. Notably, warnings about MOH must be mentioned in the SmPC of all concerned drug classes.

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Keywords : Headache, Adverse drug reaction, Medication-overuse headache, Pharmacovigilance