8.2.6 Medication-overuse headache attributed to multiple drug classes not individually overused

Identification: Female patient, 45 years old, teacher, reports daily headaches for 6 months.

Headache History:

Headaches present ≥15 days/month, lasting 4 to 12 hours/day, pulsatile in nature, and of moderate to severe intensity.

Initially had episodic migraine attacks without aura (2 to 3 times/month), but the pattern became chronic with increased use of symptomatic medications.

Medication Use:

Uses paracetamol (3 days/week), ibuprofen (2 days/week), and triptan (sporadically, 1 to 2 days/week), without exceeding the individual limit for each class (e.g., paracetamol <15 days/month, triptan <10 days/month).

Total combined days with symptomatic medications: ≥10 to 15 days/month, for >3 months.

Physical/Neurological Examination: Unremarkable.