Medication overuse headache from a tertiary headache center in Egypt: real-world insights.

BACKGROUND: Medication-overuse headache (MOH) is a secondary headache disorder often underrecognized in low- and middle-income countries. This study provides the first real-world data on MOH prevalence and clinical characteristics from a tertiary care center in Egypt. METHODS: A cross-sectional study was conducted among 120 patients with primary headaches recruited from the Headache Unit and general outpatient clinics. Patients were classified according to ICHD-3 criteria as MOH or non-MOH. Clinical characteristics, risk factors, medication use, disability using the validated Arabic version of Migraine Disability Assessment questionnaire (MIDAS) and Headache Impact Test (HIT-6), quality of life using Arabic version of Short-Form 12 Health Survey (SF-12), and psychiatric comorbidity were assessed. RESULTS: The prevalence of MOH was 65.8%. Chronic migraine was the most common underlying primary headache (80.5%). MOH patients were predominantly female (86.1%) and older, and were less educated than non-MOH patients. Risk factors significantly associated with MOH included insomnia (38% vs. 17.1%), musculoskeletal pain/fibromyalgia (43% vs. 19.5%), and physical inactivity (89.9% vs. 75.6%). The most overused medications were ergot derivatives (88.5%) and triptans (59.3%). MOH patients reported significantly higher headache frequency (mean 24.4 ± 7.1 vs. 11.2 ± 7.6 days/month, p < 0.001), greater disability (MIDAS mean 46.5 ± 28.9 vs. 19.3 ± 22.9, p < 0.001), and poorer quality of life (PCS 43 vs. 49.4; MCS 35 vs. 44, p < 0.01). Depression, anxiety, and stress scores were also significantly higher among MOH patients. CONCLUSIONS: MOH is alarmingly prevalent among Egyptian tertiary care patients, especially women with chronic migraine, emphasizing the need for national strategies on over-the-counter analgesic control and structured withdrawal programs.