Dr. Robbins noted that the mnemonic SNOOP can be used to guide physicians during the examination.
He cited new diagnostic criteria that defined medication overuse headache as “headache at least 15 days per month in a patient with pre-existing headache disorder,” and “regular overuse for more than 3 months of at least one acute/symptomatic treatment:
1. Ergotamine, triptans, opioids, or combination analgesic medications on at least 10 days per month
2. Simple analgesics or any combination of ergotamine, triptans, analgesics, or opioids on at least 15 days per month on a regular basis without overuse of any single class alone.”
Distinguishing primary from secondary headache disorders should be a top priority, Dr. Robbins explained. He urged clinicians in attendance to remain aware of “red flags.” He further noted that the “majority of primary chronic headaches are chronic migraine.”
It is important that clinicians warn patients about risk factors for progression and systemic risks associated with medication overuse, and discuss with patients the fact that about one-half of all chronic migraine is associated with acute medication overuse.