Integrated management of refractory medication-overuse headache in an elderly patient: the clinical efficacy of the Kampo medicine Goshuyuto.

CONTEXT: Medication-overuse headache (MOH) presents a significant clinical challenge, particularly in elderly patients where conventional prophylactic medications often carry risks of adverse effects and polypharmacy.

OBJECTIVE

To report a case of successful treatment of refractory MOH using Goshuyuto, a traditional Japanese Kampo medicine, after standard Western treatments and initial Kampo approaches failed.

CASE REPORT: A 79-year-old male with hypertension and diabetes presented with a chronic headache (over two months) due to daily overuse of NSAIDs and acetaminophen. Neuroimaging ruled out secondary organic causes. Based on initial "heat" patterns, Orengedokuto was prescribed but proved ineffective. A subsequent physical examination identified "coldness" in the epigastrium, leading to a prescription of Goshuyuto.

RESULTS

The patient's Visual Analog Scale (VAS) score decreased from 8.5 (at baseline) to 5.5 after two weeks and to 2.5 after two months. He achieved significant pain reduction and regained quality of life without adverse effects.

CONCLUSION

Goshuyuto may offer a safe and effective integrative approach for MOH, particularly when gastrointestinal dysfunction and thermal imbalance ("coldness") are present. This case highlights the importance of traditional abdominal examination in personalizing headache treatment.