# Medication overuse headache from a tertiary headache center in Egypt: real-world insights

## TL;DR

This study reveals that medication overuse headache is highly prevalent in Egypt, particularly among women with chronic migraines, and highlights the need for better control of pain medication use.

## Contribution

First real-world data on MOH prevalence and characteristics from a tertiary care center in Egypt.

## Key findings

- MOH prevalence was 65.8% among patients with primary headaches.
- Chronic migraine was the most common underlying condition in MOH patients.
- MOH patients had higher disability, poorer quality of life, and higher rates of psychiatric comorbidities.

## Abstract

Medication-overuse headache (MOH) is a secondary headache disorder often underrecognized in low- and middle-income countries. This study provides the first real-world data on MOH prevalence and clinical characteristics from a tertiary care center in Egypt.

A cross-sectional study was conducted among 120 patients with primary headaches recruited from the Headache Unit and general outpatient clinics. Patients were classified according to ICHD-3 criteria as MOH or non-MOH. Clinical characteristics, risk factors, medication use, disability using the validated Arabic version of Migraine Disability Assessment questionnaire (MIDAS) and Headache Impact Test (HIT-6), quality of life using Arabic version of Short-Form 12 Health Survey (SF-12), and psychiatric comorbidity were assessed.

The prevalence of MOH was 65.8%. Chronic migraine was the most common underlying primary headache (80.5%). MOH patients were predominantly female (86.1%) and older, and were less educated than non-MOH patients. Risk factors significantly associated with MOH included insomnia (38% vs. 17.1%), musculoskeletal pain/fibromyalgia (43% vs. 19.5%), and physical inactivity (89.9% vs. 75.6%). The most overused medications were ergot derivatives (88.5%) and triptans (59.3%). MOH patients reported significantly higher headache frequency (mean 24.4 ± 7.1 vs. 11.2 ± 7.6 days/month, p < 0.001), greater disability (MIDAS mean 46.5 ± 28.9 vs. 19.3 ± 22.9, p < 0.001), and poorer quality of life (PCS 43 vs. 49.4; MCS 35 vs. 44, p < 0.01). Depression, anxiety, and stress scores were also significantly higher among MOH patients.

MOH is alarmingly prevalent among Egyptian tertiary care patients, especially women with chronic migraine, emphasizing the need for national strategies on over-the-counter analgesic control and structured withdrawal programs.