{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:19:48Z","timestamp":1793139588092,"version":"4.5.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>It is not well established to what extent medication-overuse occurs in cluster headache (CH), if medication-overuse headache exists in CH and whether the existing criteria for medication-overuse headache are a suitable diagnostic tool in CH. We aimed to examine the prevalence of medication-overuse and probable medication-overuse headache in a well characterized cohort of people with CH and describe associated factors and clinical impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants diagnosed with CH according to International Classification of Headache Disorders, 3rd edition (ICHD-3) beta and ICHD-3 were invited to participate in a semi-structured interview investigating medication-overuse and probable medication-overuse headache according to ICHD-3. To add nuance to the debate, we also included a more conservative definition, applying the ICHD-3 criteria for the medication-overuse but specified the headache phenotype to a daily bilateral headache.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 21% of 433 participants with CH had a medication-overuse according to ICHD-3. Of these, 16% fulfilled the criteria for probable medication-overuse headache according to the ICHD-3, and 12% if excluding isolated triptan overuse. The overused analgesics constituted simple analgesics (52.2%), triptans (37.3%), opioids (29.9%) and combination therapies (20.9%). Associated factors were having chronic CH (odds ratio\u00a0=\u00a011.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001) and comorbid migraine (odds ratio\u00a0=\u00a02.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Participants with probable medication-overuse headache had longer attack duration (30.0 vs. 20.0\u2005minutes,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and less effect of acute and preventive medication than those without (20.0 vs. 55.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05 and 13.3 vs. 37.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01, respectively). If applying the conservative definition with a daily bilateral headache along with a medication-overuse, the prevalence was reduced to 4%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Probable medication-overuse headache was present in every sixth participant with CH in this large cross-sectional cohort study. Interestingly, only a smaller proportion was the result of isolated triptan overuse. In CH, where patients often suffer from daily attacks and may suffer from a daily bilateral inter-ictal pain, our very conservative definition noted a prevalence of 4%. While the existing ICHD-3 criteria for medication-overuse headache may not be directly applicable in CH, the applicability and validity of the very conservative definition warrant further investigation. Still, as in other cross-sectional populations with medication-overuse, we noted an association that acute and preventive treatments were less effective in participants with probable medication-overuse headache compared to those without. Altogether, future prospective studies are necessary to establish the exact extent and presentation of medication-overuse headache in CH and determine whether it is an aggravating factor for the disease. We do not recommend discontinuing triptans if suspecting MOH due to ethical concerns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03331024251364241","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T12:45:38Z","timestamp":1756471538000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Exploring medication-overuse and medication-overuse headache in cluster headache"],"prefix":"10.1177","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3062-030X","authenticated-orcid":false,"given":"Nunu","family":"Lund","sequence":"first","affiliation":[{"name":"Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet\u00a0\u2013\u00a0Glostrup, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6015-6814","authenticated-orcid":false,"given":"Marie-Louise Kulas","family":"S\u00f8borg","sequence":"additional","affiliation":[{"name":"Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet\u00a0\u2013\u00a0Glostrup, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3634-7287","authenticated-orcid":false,"given":"Louise Ninett","family":"Carlsen","sequence":"additional","affiliation":[{"name":"Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet\u00a0\u2013\u00a0Glostrup, Glostrup, Denmark"},{"name":"Department of Neurosurgery, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rigmor H\u00f8jland","family":"Jensen","sequence":"additional","affiliation":[{"name":"Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet\u00a0\u2013\u00a0Glostrup, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0125-6038","authenticated-orcid":false,"given":"Anja Sofie","family":"Petersen","sequence":"additional","affiliation":[{"name":"Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet\u00a0\u2013\u00a0Glostrup, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-023-01660-8"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024241258485"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.1.291"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4610.2000.00007.x"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.1993.hed3301018.x"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.3.908"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10194-004-0078-5"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2004.04132.x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002117"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000223332.35936.6e"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15736"},{"key":"e_1_3_3_14_2","first-page":"137","article-title":"The international classification of headache disorders, 3rd edition (beta version)","volume":"53","author":"Torelli P","year":"2013","unstructured":"Torelli P, Jensen RH, Tavanaiepour D, et al. 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