A narrative review on the management of medication overuse headache: the steep road from experience to evidence

Table 1 Proposed criteria for simple or complex medication overuse headache (see references [3, 4])

Simple MOH	Complex MOH
Short duration of MOH (3 months–1 year)	Long duration of MOH (>1 year)
Relatively modest doses of drugs^a	Daily opioids or combination medication with more than one prescription drug
Minimal psychiatric contribution^b (one or two axis I clinical syndromes)	Multiple psychiatric comorbidities including personality disorders
No history of relapse after withdrawal	History of relapse following withdrawal

^aUp to two triptans and three analgesics per day
^bPsychological issues contributing to the perpetuation of MOH include: (a) the belief that drug(s) is(are) the only solution, (b) anticipatory fear of pain (cephalalgiophobia), (c) difficulty tolerating discomfort, (d) sedation seeking, (e) outside pressure, need to function, (f) axis I, clinical syndrome, (g) axis II personality disorders

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