What is the 20 10 rule

Drug Overuse Headache: 10-20 rule

Around 50% of patients with more than 15 headache days per month for at least 3 months have, in addition to the original primary form of headache, an additional causal reason for the increasing number of headache days per month, a drug overuse headache (MÜK ). Knowledge of drug overuse headache (MÜK) is a crucial component of treatment. Most of those affected show adequate treatment in contrast to the initial situation after a drug break

  • a reduction in headache days per month
  • a renewed response to preventive and acute medication

The simple advice, the knowledge of the context and the consequences of the drug overuse headache (MÜK) is an essential component of the treatment. This knowledge alone can be enough to understand the processes, to behave correctly and to implement the 10-20 rule for prevention.

We have therefore derived the “10-20 rule” for avoiding and recognizing drug overuse headache (MCA) from the limits on the frequency of intake of the international headache classification (ICHD-3 beta). The upper limit was set at 10 intake days per month to increase safety, even if this threshold for monoanalgesics is set at 15 days per month. However, severely affected patients usually do not use exclusively mono-analgesic treatment, so that the 10-20 rule can generally be used as a basis:

  • Pain relievers and specific migraine drugs should be used a maximum of 10 days per month be used.
  • 20 days a month should be completely free from their ingestion.
  • With this rule, the tablets used on the 10 days are not counted, but only the respective day, regardless of the amount taken.
  • This also means: Better to treat on one day with an adequate dose than on several days with too low a dose.
  • Recording the days of headache and taking the medication during the course of the month with a pain calendar is therefore essential for modern headache therapy.

In principle, every drug that is effective in the acute therapy of primary headaches seems to be able to produce headaches itself if used incorrectly. The decisive factor is the intake behavior over time. A distinction is made between painkillers and ergotamine or triptan-induced headaches.

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