DECREASED EFFECTIVENESS AND SAFETY OF MEDICINES FOR HEADACHES: A LITERATURE REVIEW
DOI:
https://doi.org/10.11603/2312-0967.2025.4.15708Keywords:
headache, headache management, medication-induced pain, pharmacological tolerance, drug dependence, addictive behaviorAbstract
The aim of the work. To analyze current data on the pharmacodynamics of drugs used in the management of headache, and to assess possible factors contributing to reduced efficacy and safety, particularly the development of medication-overuse headache and dependence or dependence-like behavior.
Materials and methods. A comprehensive selection and analysis of relevant literature was conducted, encompassing meta-analyses, registry data, review articles, and original studies published between 2020 and 2025. These were retrieved and analysed using the Google Scholar, PubMed, and Consensus search engines.
Results and Discussion. The results of the literature review show that the effectiveness of drugs for headaches largely depends on the type of headache, its severity, and the timeliness of administration. However, even when following the recommended treatment regimens, a gradual decrease in effectiveness is observed with frequent or uncontrolled use. Excessive or improper use of analgesics, in particular nonsteroidal anti-inflammatory drugs, triptans, or opioids, contributes to the development of medication-induced headaches, tolerance, dependence, or addictive behavior. Central sensitization, neuroimmune and epigenetic mechanisms that maintain pathological excitability of neurons even after the removal of the primary stimulus play an important role in the chronicity of pain syndrome. Data from the DMKG international registry confirm a trend toward decreased efficacy of analgesics and triptans with increased frequency of headache attacks, regardless of the presence of abuse syndrome.
Conclusions. Frequent or uncontrolled use of medications for headaches has been demonstrated to result in a decrease in their effectiveness and the development of medication-induced headaches. This is associated with the onset of dependence/dependence-like behaviour.
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