Practical strategies for treating chronic migraine with medication overuse: case examples and role play demonstrations.

Patients with chronic migraine headaches complicated by medication overuse (MO) present some of the most difficult treatment challenges for headache practitioners. Recent research has identified a variety of risk factors (including MO) that appear to be associated with the escalation of the frequency and severity of migraine headache. Management of such patients with medication overuse headaches (MOH) may become more problematic due to co-morbid psychiatric issues common with migraine patients and the patient's reluctance to limit/eliminate "overused" abortive medications. Medication adherence becomes an important treatment concern. The present article will highlight treatment issues that must be considered in the assessment and treatment of patients with chronic migraine and MOH. Case examples will be offered to illustrate the process of the implementation of these strategies.