8.2.5 Combination-analgesic-overuse1 headache

Diagnostic criteria:
  1. Headache fulfilling criteria for 8.2 Medication-overuse headache
  2. Regular intake of one or more combination-analgesic medications1,2 on ≥10 days/month for >3 months.
  1. The term combination-analgesic is used specifically for formulations combining drugs of two or more classes, each with analgesic effect (for example, paracetamol and codeine) or acting as adjuvants (for example, caffeine). Drugs that combine only two non-opioid analgesics (such as acetylsalicylic acid and paracetamol), without an adjuvant, are not considered combination-analgesics since, for the purposes of ICHD-3, both drugs are in the same class.
  2. The combination-analgesic(s) should be specified in parenthesis.

Many combination-analgesics are marketed. They tend to be widely used by people with headache, and are very commonly implicated in 8.2 Medication-overuse headache. For this reason, 8.2.5 Combination-analgesic-overuse headache has a separate coding.

The most commonly overused combination-analgesics combine non-opioid analgesics with opioids, butalbital and/or caffeine.