To synthesize global data characterizing the burden of medication overuse headache (MOH).

Frequent use of acute medications for migraine is associated with a disabling secondary disorder, MOH; affecting 30% of patients with migraines at specialty clinics. Literature to characterize the burden of MOH is limited; and a formal synthesis is lacking.

A systematic literature review, conducted using MEDLINE and EMBASE using PICOS criteria, identified articles characterizing the burden associated with acute treatments for migraine. Outcomes among subjects with MOH were summarized: 1) percentage overusing acute medications by class; 2) percentage with unsuccessful withdrawal (inability to discontinue the overused medication); and 3) factors associated with unsuccessful withdrawal.

From 5,770 records identified, 743 full-text articles were screened; 15 studies were included that reported on outcomes among subjects with MOH. Data were identified from North America, Europe, Asia, and South America; and most studies identified subjects through medical records using ICHD criteria. Among those with MOH, the percentage overusing triptans varied from 0% to 46%, combination analgesics 17%-71%, opioids 0%-48%, and ergots 2%-43%; opioid (48%) and triptan (16%) use was common among North American subjects attending an inpatient withdrawal program. The rate of unsuccessful withdrawal at 1-year ranged from 21%-40%. Unsuccessful withdrawal was associated with the presence of mood disorders and anxiety, duration of MOH, medication type, greater migraine-related disability, and frequency. Data were largely available from inpatient programs, which may reflect a more severe patient population.

These data characterize the burden of MOH and demonstrate an unmet need for acute treatments that do not confer a risk of MOH. Further research using real-world data from a large representative sample of adults with migraine who develop MOH is needed to characterize the clinical, humanistic, and economic burden of MOH among subjects using acute treatment for migraine.