Sleep disorders in patients with medication-overuse headache

Sleep disorders are common among individuals with end-stage renal disease (ESRD) on dialysis and can persist after renal transplantation. This study aims to compare the association of sleep disorders between matched groups of patients with ESRD on dialysis and those who have undergone renal transplants. This is a clinic-based cross-sectional study conducted in patients with post-organ transplant and patients with ESRD on dialysis. The study involved, in addition to demographic data, administering structured sleep questionnaires, including the Epworth Sleepiness Scale (ESS), Berlin Questionnaire (BQ), STOP-BANG questionnaire, Pittsburgh Sleep Quality Index (PSQI), and questionnaires for insomnia and Restless legs syndrome (RLS). The study analyzed a total of 386 participants, comprising 227 (58.8%) patients with ESRD on dialysis and 159 (41.2%) who had undergone renal transplants. The results from the unmatched analysis revealed that renal transplantation patients have significantly lower odds of sleep disorders compared to ESRD on dialysis. After matching, the renal transplant remains significant associated with decreased odds of sleep disorders; insomnia (OR = 0.083, 95% CI: 0.030-0.231), EDS (OR = 0.034, 95% CI: 0.005-0.253), RLS (OR = 0.229, 95% CI: 0.106-0.493), poor sleep quality (OR = 0.265, 95% CI: 0.127-0.552), the likelihood of high risk for OSA using BQ (OR = 0.217, 95% CI: 0.119-0.395), high risk for OSA using STOP-BANG criteria (OR = 0.122, 95% CI: 0.063-0.236). There was no significant difference in sleep disorders due to the duration since transplant. This study confirms the ongoing effects of end-stage renal disease (ESRD) on sleep disorders in patients and highlights the benefits associated with renal transplantation in reducing the risk of OSA, insomnia, RLS, and improving overall sleep quality. However, a significant limitation of this study is that OSA was not assessed objectively through a formal sleep study.

Don’t Let Your Patients Lose Sleep Over Insomnia

The topic 'Emerging Talents in Sleep Disorders' is dedicated to highlighting students and early career researchers within the field of sleep disorders. They are bringing exciting new ideas to the field. However, many of these ideas are not communicated to a broader audience. We recognize that this is because many students and early career researchers may lack a platform to share their ideas. This topic gives an opportunity to succeed with their manuscripts.Chen Tien-Yu et al., reported the prevalence and effects of sleep-disordered breathing on middle-aged patients with sedative-free generalized anxiety disorder ( https://doi.org/10.3389/fpsyt.2022.1067437 ). Generalized anxiety disorder (GAD) and sleepdisordered breathing (SDB) share similar symptoms, such as poor sleep quality, irritability, and poor concentration during daily activities. This study investigates the proportion of undiagnosed SDB and its impacts on anxiety severity and autonomic function in newly diagnosed, sedativefree GAD patients. They found that an average age 55 years and mean BMI 23 kg/m2 patients with GAD and matched controls had an undiagnosed SDB prevalence of approximately 50%. Also noticed that SDB correlated with worsening anxiety severity and reduced cardiac autonomic function. Importantly, age and BMI were major risk factors for predicting undiagnosed SDB. Nakajima S et al described the transdiagnostic association between subjective insomnia and depressive symptoms in major psychiatric disorders (https://doi.org/10.3389/fpsyt.2023.1114945). Comorbid depressive symptoms are associated with clinically important issues such as reduced quality of life, a poor prognosis, and increased suicide risk. This study investigated whether the association between insomnia and depressive symptoms is also found in other psychiatric disorders. In schizophrenia, a relation between depressive symptoms and insomnia was also found by objective sleep assessment methods using sleep EEG. Their results suggest that the association between subjective insomnia and depressive symptoms is a transdiagnostic feature in major psychiatric disorders.Ding Q et al examined validation of a portable monitor compared with polysomnography for screening of obstructive sleep apnea in polio survivors (https://doi.org/10.3389/fneur.2023.1137535). Sleep-disordered breathing (SDB) is highly prevalent in polio survivors. Obstructive sleep apnea (OSA) is the most frequent type. Full polysomnography (PSG) is recommended for OSA diagnosis in patients with comorbidities by current practice guidelines, but it is not always accessible. They studied whether type 3 portable monitor (PM) or type 4 PM might be a viable alternative to PSG for the diagnosis of OSA in post-polio subjects. The insightful study showed Type 3 PM and Type 4 PM could be alternative ways to screen OSA for polio survivors, especially for moderate to severe OSA. Sun J et al reviewed Global research on cancer and sleep: a bibliometric and visual analysis of the last two decades (https://doi.org/10.3389/fneur.2023.1139746). This systemic review analyzed the research status, hotspots, and frontiers of global research on cancer and sleep through bibliometrics and provided references and guidance for future research. Cancer and sleep disruption and the influencing factors of sleep quality is an emerging topic. This study systematically analyzed the hotspots and frontiers in the field of cancer and sleep research. The authors named multiple foal topics for further research studies such as, intervention measures for the cancer symptom cluster, the bioavailability of exogenous melatonin, the relationship between OSA and cancer, the mechanism of tumor-induced sleep disruption, the dose-response relationship between sleep duration and cancer risk.Sleep problems are a growing public health concern worldwide. The 2023 Sleep in America poll conducted by the National Sleep Foundation showed that almost 65% of adults who are dissatisfied with their sleep have mild or severe depressive symptoms (1). The International Classification of Sleep Disorders by American Academy of Sleep Medicine lists 60 specific sleep disorders, the most common of which are insomnia, sleep apnea, restless legs syndrome, and narcolepsy (2).The close association between altered sleep pattern and diseases makes sleep a valuable diagnostic biomarker for non-invasive early diagnosis of some diseases. As sleep disorders increase with age and age is considered one of the major predictors of morbidity and mortality. Despite the diverse nature of sleep disorders, they have far-reaching, detrimental effects on population health and increase both morbidity and mortality of various chronic diseases (3). The chronic effects of sleep disorders deserve more attention from doctors, researchers, and society. As well as a better understanding of the mechanisms of sleep, new approaches to diagnose and treat sleep disorders are urgently needed. The editorial team thanks reviewers for their constructive criticism.

Psoriasis is a chronic inflammatory skin disease which can cause sleep disturbances due to the disease itself or due to its complications. In this study, we aimed to analyze the array of sleep disturbances caused by psoriasis and to evaluate the interaction between the quality of sleep and the duration and severity of psoriasis. Study subjects included 60 patients with plaque psoriasis and 60 sex- and age-matched controls. The Psoriasis Area and Severity Index (PASI) was used to evaluate severity of disease. Body mass index (BMI), medication usage, and duration of disease were recorded. All subjects completed the Epworth Sleepiness Scale (EES), Pittsburgh Sleep Quality Index (PSQI), insomnia severity index (ISI), Berlin-sleep apnea questionnaire, and questions based on criteria of the International Restless Legs Syndrome Study Group indicating the presence of restless legs syndrome (RLS). There were statistically significant and clinically relevant differences between the patients and controls regarding day-time sleepiness (ESS 5.3 vs 4.1, p = 0.037), sleep quality (PSQI 14.4 vs 4.9, p < 0.001), insomnia (ISI 19.7 vs 14.4, p < 0.001), sleep apnea (high risk 30% vs 7%, p = 0.01), and RLS (high risk 32% vs 0%, p < 0.001). Patients with psoriasis experience poor sleep quality and are at markedly increased risk for insomnia, obstructive sleep apnea, and restless legs syndrome. These findings suggest the importance of evaluating patients with psoriasis for conditions that affect sleep. The study results further suggest that simple screening tools may be useful for this task.

Background. Sleep disorders have a negative impact on many aspects of life. COVID-19 exacerbates this problem in the context of the post-COVID syndrome where sleep disorder is one of the common complaints.Objective. We aimed to assess the frequency of sleep disorders after COVID-19 and the presence of associations between post-COVID sleep disorders and the severity of COVID-19.Material and methods. A cross-sectional study was carried out in Novosibirsk. It included 115 people aged 26 to 74 years (an average age of 54.22 ± 12.48 years) after recovery from COVID-19, which occurred two to eleven months before. Patients underwent questionnaire survey (Spiegel sleep score questionnaire, HADS Anxiety and Depression Scale, International Restless Legs Syndrome (RLS) Severity Scale), examination by a somnologist, and screening night computer pulse oximetry. If an index of desaturations was more than five per hour, we performed overnight somnography by WAtch PAT 200 or polysomnography. Patients were divided into groups depending on the presence of sleep disorders, COVID-19 severity, and their age. Statistical analysis included a descriptive analysis. Odds ratio was assessed by determining the risk measure for dichotomous variables in the contingency table.Results. RLS was the most common post-COVID sleep disorder (n = 63, 75%). However, primary insomnia was diagnosed only in patients with moderate-to-severe course of COVID-19 (n = 3, 9%). There were 40 patients with post-COVID sleep disorder; they had significantly lower sleep time on workdays (7.00 [6.00; 7.50] vs. 7.50 [6.50; 8.00] hours, p = 0.021) and significantly higher mean HADS depression score (5.00 [3.00; 7.00] vs. 3.00 [1.00; 6.00] points, p = 0.006) compared with the corresponding parameters in patients without deterioration of sleep quality. The chance of reduced sleep quality was 11.6 times higher after moderate-to-severe COVID-19 infection than that after mild infection only in patients aged 26-59 years (95% confidence interval 1.42–94.32, p = 0.007).Conclusion. The chance of worsening sleep quality was significantly higher after a moderate-to-severe COVID-19 infection than after mild infection in 26-59-year-old old patients. At the same time, RLS was the most common post-COVID sleep disorder according to our study. Given the importance of sleep disorders, working-age patients after moderate-to-severe COVID-19 infection require active monitoring by doctors in order to timely correct emerging complaints.

Sleep disorders in patients with epilepsy

Introduction Insomnia and restless legs syndrome (RLS) are common sleep disorders that may impact obstructive sleep apnea (OSA) treatment. To our knowledge, no studies have investigated whether these comorbidities affect upper airway stimulation (UAS) therapy adherence and outcomes. This study aims to explore possible effects of insomnia and RLS in patients using UAS therapy. Methods All patients who underwent UAS system implantation for treatment of OSA at our facility were retrospectively studied. Pre- and post-implant histories and data, including diagnostic sleep testing, otolaryngology evaluation, activation results, and treatment evaluation, were analyzed. Patients with no insomnia or RLS were compared to patients with insomnia, RLS, or both. Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and adherence were compared pre- and post-treatment for each group. Results Sixty-four patients who have undergone UAS implantation at our center have completed post-treatment in-lab titration and evaluation of their UAS system. Insomnia was present in 47%, RLS in 28%, and both insomnia and RLS in 14%. In all groups, the overall AHI during in-lab titration was &amp;gt;50% lower than the pre-treatment AHI (16.1+/-14.3/h vs 32.5+/-13.1/h, p&amp;lt;0.001). While the trend in AHI reductions suggested a lower AHI in those without insomnia or RLS, the reduction did not reach statistical significance (no insomnia or RLS 15.7+/-12.9/h, insomnia 16.9+/-16.7/h, RLS 19.0+/-15.5/h, both insomnia and RLS 23.4+/-18.4/h). UAS therapy usage was reduced in patients with RLS (3.9+/-2.6 h/night, p=0.029) and in patients with both insomnia and RLS (3.9+/-1.3 h/night, p=0.046) compared to patients with neither comorbidity (5.9+/-1.9 h/night). Mean reduction in ESS was similar across groups, averaging from 11+/-5 pre-treatment to 7+/-5 post-treatment (p&amp;lt;0.001). Conclusion Insomnia and RLS are common in patients using UAS therapy for OSA. Pre- and post-treatment residual AHI and ESS significantly improved in all patient groups assessed. A decrease in UAS usage was present in patients with RLS and both RLS and insomnia. Our study suggests that identification and treatment of RLS and insomnia may play an important role for UAS therapy adherence and efficacy, thus, optimizing care. Support (if any):

Respiratory-related leg movements (RRLMs) may contribute to the cardiovascular risk associated with obstructive sleep apnea (OSA). Selective serotonin reuptake inhibitors (SSRIs), but not bupropion, increase periodic leg movements in sleep. This study examines whether patients with OSA using SSRIs have more RRLMs than those taking bupropion or no antidepressant. Patients with an apnea-hypopnea index (AHI) of at least 10 events/h during a full-night diagnostic study or split-night study, who were taking bupropion (n = 32), an SSRI (n = 31), or no antidepressant (n = 31), were selected from a database of prestudy questionnaires. RRLMs were scored according to World Association of Sleep Medicine 2016 standards. Patients using SSRIs had significantly greater overall RRLM% (defined as the percentage of respiratory events associated with a leg movement, including apneas, hypopneas, and respiratory effort-related arousals), RRLM index, and periodic limb movement index relative to patients using bupropion and control patients. The difference between the RRLM% in the SSRI and bupropion groups was limited to patients undergoing split-night studies, and that of the SSRI and control groups was limited to patients undergoing full-night diagnostic studies. The greater number of RRLMs and PLMs in the SSRI group may contribute to treatment-emergent insomnia often seen with SSRI use. Fragmented sleep and elevated autonomic nervous system activation associated with increased RRLMs in patients with OSA taking SSRIs might also limit the tolerability of antidepressant treatment, as well as increase the risk for cardiovascular disease.

Objective To investigate the clinical characteristics of restless legs syndrome (RLS) in adults in Peking Union Medical College Hospital and explore the sleep quality,fatigue degree,daytime sleepiness,disease severity,depression and anxiety of RLS patients.Methods Totally 4739 consecutive patients who visited the outpatient departments with any sleep complaint or leg discomforts were recruited in the study. Patients under 18 years were excluded. All participants answered RLS questionnaire. The subjects fulfilled all four criteria would be followed up and given advanced examinations to rule out secondary RLS and RLS mimics. Primary RLS patients were evaluated with International Restless Legs Scale (IRLS),Pittsburgh Sleep Quality Index (PSQI),Fatigue Severity Scale (FSS),Epworth Sleepiness Scale (ESS),and Hospital Anxiety and Depression Scale for depression and anxiety (HADD and HADA). Another two groups of age-and gender-matched healthy subjects and non-RLS insomnia patients were served as normal and non-RLS insomnia controls.Results There were 162 (3.42%,162/4739) subjects fulfilling all four criteria for RLS; 42 (0.89%,42/4739) subjects were diagnosed as primary RLS and 33 (0.70%,33/4739) as RLS mimics. In primary RLS patients,41(97.6%) were found to be with poor sleep,13 (31.0%) with anxiety,and 4(9.5%) with depression. The scores of PSQI(q=11.69,P=0.000),HADA(q=8.02,P=0.000),and HADD(q=6.60,P=0.000)in primary RLS patients were significantly higher than those in normal controls. The scores of FSS(q=3.74,P=0.001),ESS(q=2.97,P=0.012),and HADD(q=4.15,P=0.000) in primary RLS patients were significantly lower than those in non-RLS insomnia controls. The scores of HADA and HADD were significantly correlated with those of PSQI(r=0.340,P=0.028;r=0.383,P=0.012),FSS(r=0.445,P=0.003;r=0.511,P=0.001),and IRLS(r=0.477,P=0.001;r=0.578,P=0.000). Conclusions RLS should be considered in the patients with any sleep-related complaint or leg discomforts. Primary RLS patients suffer from bad sleep and are more susceptible to anxiety and depression. Secondary RLS and RLS mimics should be excluded before the diagnosis of primary RLS.

To determine the differences and associations between nocturnal voiding (NV)/nocturia and sleep disorders. Using an epidemiological survey, we compared residents with non-bothersome NV (NNV) and bothersome NV (BNV) to those with sleep disorders, including insomnia, obstructive sleep apnoea syndrome (OSAS), restless leg syndrome (RLS), and periodic limb movement disorder (PLMD), for patient background, lower urinary tract symptoms (LUTS), sleep status, and general health-related quality of life (HRQL). Furthermore, we investigated associations between BNV and sleep disorders using multivariate analyses. In all 2271 (38%) answers were available, of which 729 (32%), 966 (43%) and 546 (24%) subjects had no NV, NNV and BNV, respectively, and 348 (15%), 52 (2%), 172 (8%) and 62 (3%) were determined as having insomnia, OSAS, RLS and PLMD, respectively. For LUTS, subjects with BNV were significantly worse than those with OSAS, but better than those with RLS and PLMD. Total sleep status in the BNV group was better than that in the insomnia group, but worse than that in the OSAS and RLS groups. General HRQL in the BNV group was worse than that in the OSAS group, and better than that in the RLS and PLMD groups for physical aspects. In mental aspects, subjects with BNV were better than those with insomnia. Insomnia and OSAS had a close correlation with NNV/BNV (P < 0.001-0.022), and PLMD had a significant correlation with BNV (P = 0.031). However, RLS was not associated with NV (P = 0.42) nor with BNV (P = 0.09). NV/nocturia is closely related to sleep disorders, but obviously different from them in several aspects.

Purpose: To determine the prevalence of common sleep problems among patients with rheumatoid arthritis (RA) and their relationship with the disease activity and quality of life.Patients and methods: The study sample consisted of 101 patients who attended a rheumatology clinic at a university hospital between October 2015 and May 2016. All subjects were clinically examined and interviewed by physicians using a questionnaire. The collected information included sociodemographic characteristics, the patients’ medical histories, the Disease Activity Score (DAS28), the Berlin questionnaire to assess the risk of obstructive sleep apnea (OSA), the Epworth Sleepiness Scale to assess excessive daytime sleepiness (EDS), the Athens Insomnia Scale to assess insomnia, the International RLS Study Group score to diagnose restless legs syndrome (RLS), and the Health Assessment Questionnaire (HAQ) to assess the quality of life.Results: The mean age of the participants was 48.7±14.6 years, and 95% of the participants were females. Approximately 60% of the participants were in the remission/low category of disease activity, and the average DAS28 score was 3.3±0.8 years. The prevalence rates of insomnia, EDS, sleep disturbance, risk of OSA, and RLS were 63%, 20%, 20%, 37%, and 63%, respectively. Furthermore, the distribution of sleep disorders was not affected by the disease activity. The association between the HAQ and sleep disorders among the RA patients was not significant.Conclusion: Sleep disorders are common among RA patients and may require further attention by treating clinicians; nevertheless, these disorders are not associated with disease activity and do not affect the quality of life.

The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apnea-hypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook. Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of -7.6 events/h (95% confidence interval [CI] = -11.7 to -3.5; P ≤ .001), apnea index of -4.2 events/h (95% CI = -7.7 to -0.8; P ≤ .016), Epworth Sleepiness Scale of -2.5 of 24 (95% CI= -5.1 to -0.1; P ≤ .066), Pittsburgh Sleep Quality Index of -1.3 of 21 (95% CI= -2.4 to -0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls. This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.

Neuropeptides and peripheral sensory processing

In his famous monograph “An Essay in Shaking Palsy,” James Parkinson provided astute descriptions of impaired sleep in his case series of patients with Parkinson's disease (PD) two centuries ago. It is only three decades ago that sleep dysfunction started to attract attention of medical and scientific communities involved in the clinical care and research of PD. Tremendous advancements in our understanding of impaired sleep and alertness associated with PD have developed since then. Sleep problems are one of the major, challenging issues in patients with PD, affecting a significant number of patients. The etiology of sleep problems is multifactorial, including disease-related nocturnal symptoms, medication adverse effects, and primary sleep disorders including restless legs syndrome, rapid eye movement sleep behavior disorder, and sleep apnea syndrome. These causes of impaired sleep-wake cycles in the PD population often coexist or even overlap, rendering the management of sleep problems in PD patients difficult. Also, excessive daytime sleepiness is observed in a significant number of patients. In PD patients, therefore, appropriate assessment of disease-related nocturnal disturbances and primary sleep disorders is imperative. This special issue addresses unmet need for understanding PD-related sleep problems. PD sleep scale 2 (PDSS-2) is a recently developed tool for screening and managing sleep disturbance in PD patients, consisting of 15 items which are clinically relevant to nocturnal problems including nonmotor and motor problems in PD [1]. The original PDSS-2 (German and English) has been translated into several languages, including Japanese [2] and Italian [3]. The PDSS-2 has been used to observe treatment response. In a double-blind, placebo-controlled trial, including 287 PD patients, mean PDSS-2 total score decreased by −5.9 points with rotigotine and by −1.9 points with placebo [4]. In this special issue, K. Horvath et al. estimated the threshold representing minimal clinically important difference of the PDSS-2 total score: the study results showed −3.44 points for detecting improvement or the threshold of 2.07 points for observing worsening. This finding is important when planning studies using the PDSS-2 as outcome measures. Full-night polysomnography (PSG) is a gold standard for diagnosing sleep apnea syndrome; however, applying PSG is often difficult in patients with PD, who have severe parkinsonism or psychiatric comorbidity. P. Gros et al. evaluated the usefulness of unattended portable monitoring (PM) for diagnosis of obstructive sleep apnea (OSA) in patients with PD. Although discrepancy between portable monitoring and PSG was greater in PD patients with more motor dysfunction, the authors confirmed the usefulness of portable monitoring in diagnosing moderate to severe OSA in PD patients. These results provide the rationale for the use of portable sleep monitoring in PD and are very relevant for circumstances where a complete PSG in a sleep laboratory is not available and/or feasible. M. Kaminska et al. performed a review on the relationship between OSA and PD. Although the clinical significance of OSA in PD has been controversial [5, 6], the authors suggest the possibility that treatment of OSA could delay cognitive decline or motor dysfunction in patients with PD. This area of research is of high significance as it is important to assess the prevalence of OSA and the impact of its treatment in the PD population. D. Martinez-Ramirez et al. correlated PSG findings and sleep disorders with clinical characteristics in PD patients and found that sleep disorders and sleep architecture were poorly predictable by clinical characteristic of PD patients. This comprehensive study demonstrates the complexity of sleep dysfunction associated with PD and its complex associations with metrics of PD. In a fine and thoughtful study K. Suzuki et al. provided an interesting insight into the complex relationship between PD and restless legs syndrome (RLS) and leg motor restlessness (LMR). A significant relationship between RLS and PD is suggested by observing a favorable response to dopaminergic treatment in both disorders. However, RLS prevalence in PD patients varies according to different studies. Recently, LMR, characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported more frequently in patients untreated with PD than healthy controls. This review article may provide a new insight into the relationship between RLS, LMR, and PD. Finally, the complex and still only partially understood interaction of impulse control disorders in PD and sleep is discussed in a review from the clinic of one of the guest editors. In summary, sleep problems are common but underreported by PD patients and underdiagnosed by health professionals. Further understanding of mechanisms that underlie impaired sleep and alertness in PD will allow for development of much needed treatment approaches for this nonmotor manifestation of PD. Koichi Hirata Birgit Hogl Eng King Tan Aleksandar Videnovic

Objective To investigate the clinical features of medication overuse headache (MOH) to provide data for the diagnosis and treatment of MOH.Methods Eighty-eight patients with MOH,admitted to our hospital from August 2011 to March 2012,were chosen in our study; the demographic characteristics,headache characteristics,concomitant symptoms and disability of these patients were analyzed statistically.Results MOH patients (aged 47.0±17.5 years and 80％ being women) had the following characteristics:moderate to severe pain (98％),throbbing or distending pain (51％ and 42％,respectively),locating in full head or temporal top,sleep disorders (70％),emotional irritability (50％) and depression (20％).Migraine Disability Assessment Questionnaire showed that about 63.15％ patients had severe degree of disability and Headache Impact Test (HIT-6) indicated about 73.68％ patients.The over-used medication was combination analgesic,including non-steroid anti-inflammatory drug and caffeine in 76 patients (86％),Chinese patent drug in 10 patients (12％) and non-steroid anti-inflammatory drug in 2 patients (2％).Conclusion Most MOH patients are old women with chronic migraine,whose typical characteristics of headache are moderate to severe throbbing or distending pain in full head or temporal top,often accompanied with depression,dysphoria and sleeplessness,which affects life deeply. Key words: Headache; Medication overuse; Clinical characteristic; Combination analgesic; Disability