The Global Burden of Disease study conducted in 2015 estimated that around 59 million people worldwide suffered from MOH.[7]GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-602.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31678-6/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27733282?tool=bestpractice.com
Epidemiological data suggest that the prevalence of MOH in the general adult population ranges from 0.5% to 2.6%.[8]Westergaard ML, Hansen EH, Glümer C, et al. Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: a systematic review. Cephalalgia. 2014 May;34(6):409-25.
https://journals.sagepub.com/doi/10.1177/0333102413512033
http://www.ncbi.nlm.nih.gov/pubmed/24293089?tool=bestpractice.com
Peak prevalence of MOH occurs in the 50-60 years age group.[9]Diener HC, Dodick D, Evers S, et al. Pathophysiology, prevention, and treatment of medication overuse headache. Lancet Neurol. 2019 Sep;18(9):891-902.
http://www.ncbi.nlm.nih.gov/pubmed/31174999?tool=bestpractice.com
Data for children and adolescents are limited, although schools-based studies in African and Asian nations found that prevalence increases from childhood (mean 0.4%) to adolescence (mean 1.2%).[10]Ashina S, Terwindt GM, Steiner TJ, et al. Medication overuse headache. Nat Rev Dis Primers. 2023 Feb 2;9(1):5.
http://www.ncbi.nlm.nih.gov/pubmed/36732518?tool=bestpractice.com
It is estimated that approximately one third of chronic migraine patients experience MOH, and this prevalence can be even higher in specialised healthcare centres.[11]Cheung V, Amoozegar F, Dilli E. Medication overuse headache. Curr Neurol Neurosci Rep. 2015 Jan;15(1):509.
http://www.ncbi.nlm.nih.gov/pubmed/25398377?tool=bestpractice.com
[12]Munksgaard SB, Jensen RH. Medication overuse headache. Headache. 2014 Jul-Aug;54(7):1251-7.
http://www.ncbi.nlm.nih.gov/pubmed/24990298?tool=bestpractice.com
[13]Irimia P, Palma JA, Fernandez-Torron R, et al. Refractory migraine in a headache clinic population. BMC Neurol. 2011 Aug 1;11:94.
https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-94
http://www.ncbi.nlm.nih.gov/pubmed/21806790?tool=bestpractice.com
[14]Bigal ME, Rapoport AM, Sheftell FD, et al. Transformed migraine and medication overuse in a tertiary headache centre - clinical characteristics and treatment outcomes. Cephalalgia. 2004 Jun;24(6):483-90.
https://journals.sagepub.com/doi/10.1111/j.1468-2982.2004.00691.x
http://www.ncbi.nlm.nih.gov/pubmed/15154858?tool=bestpractice.com
The Nord-Trøndelag Health Survey (HUNT), an 11-year longitudinal population-based cohort study conducted in Norway, found an incidence rate for MOH of 0.72 cases per 1000 person-years.[4]Hagen K, Linde M, Steiner TJ, et al. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies. Pain. 2012 Jan;153(1):56-61.
http://www.ncbi.nlm.nih.gov/pubmed/22018971?tool=bestpractice.com
It identified female sex, anxiety or depression, low educational level, migraine as the pre-existing headache type, and use of sedatives as risk factors for developing MOH.[4]Hagen K, Linde M, Steiner TJ, et al. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies. Pain. 2012 Jan;153(1):56-61.
http://www.ncbi.nlm.nih.gov/pubmed/22018971?tool=bestpractice.com
Cross-sectional studies provide further evidence that MOH is more common among females, and individuals with lower education and income levels.[15]Westergaard ML, Glümer C, Hansen EH, et al. Prevalence of chronic headache with and without medication overuse: associations with socioeconomic position and physical and mental health status. Pain. 2014 Oct;155(10):2005-13.
http://www.ncbi.nlm.nih.gov/pubmed/25020001?tool=bestpractice.com
[16]Jonsson P, Hedenrud T, Linde M. Epidemiology of medication overuse headache in the general Swedish population. Cephalalgia. 2011 Jul;31(9):1015-22.
https://journals.sagepub.com/doi/10.1177/0333102411410082
http://www.ncbi.nlm.nih.gov/pubmed/21628444?tool=bestpractice.com
Among migraine patients, acute headache medication overuse is associated with factors including increasing age, smoking, presence of psychological symptoms, scalp allodynia, migraine symptom severity, and higher headache intensity.[2]Schwedt TJ, Alam A, Reed ML, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain. 2018 May 24;19(1):38.
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0865-z
http://www.ncbi.nlm.nih.gov/pubmed/29797100?tool=bestpractice.com
Triptans are the most commonly overused drugs, followed by opioids and barbiturates, while MOH is less frequent among non-steroidal anti-inflammatory drug (NSAID) users.[2]Schwedt TJ, Alam A, Reed ML, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain. 2018 May 24;19(1):38.
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0865-z
http://www.ncbi.nlm.nih.gov/pubmed/29797100?tool=bestpractice.com
Furthermore, conditions such as depression, anxiety, or chronic musculoskeletal disorders may contribute to medication overuse.[4]Hagen K, Linde M, Steiner TJ, et al. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies. Pain. 2012 Jan;153(1):56-61.
http://www.ncbi.nlm.nih.gov/pubmed/22018971?tool=bestpractice.com
MOH imposes a significant healthcare burden and incurs substantial costs, primarily due to lost productivity and frequent use of healthcare resources among those affected.[9]Diener HC, Dodick D, Evers S, et al. Pathophysiology, prevention, and treatment of medication overuse headache. Lancet Neurol. 2019 Sep;18(9):891-902.
http://www.ncbi.nlm.nih.gov/pubmed/31174999?tool=bestpractice.com
[10]Ashina S, Terwindt GM, Steiner TJ, et al. Medication overuse headache. Nat Rev Dis Primers. 2023 Feb 2;9(1):5.
http://www.ncbi.nlm.nih.gov/pubmed/36732518?tool=bestpractice.com