From the Guidelines
Non-Steroidal Medication Overuse Disorder (NSMOD) is a condition where patients develop worsening or rebound symptoms due to frequent, excessive use of non-steroidal medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and aspirin. This disorder most commonly occurs in the context of headache treatment, where it's often called medication overuse headache. NSMOD typically develops when these medications are used more than 10-15 days per month for three consecutive months or longer, as defined by the American College of Physicians in their 2025 clinical guideline 1. The treatment involves complete withdrawal of the overused medication, which often causes temporary worsening of symptoms for 1-2 weeks before improvement occurs, as recommended by the Nature Reviews Neurology in 2021 1. During withdrawal, supportive treatments may include hydration, rest, and possibly short-term use of alternative pain management strategies under medical supervision. Prevention focuses on limiting NSAID use to no more than 2-3 days per week and addressing underlying pain conditions appropriately. Some key points to consider in the management of NSMOD include:
- Medication overuse headache is a potential complication of migraine treatment, defined as headache occurring on 15 or more days per month for at least 3 months in people with a preexisting headache disorder that develops because of overuse of acute medication 1.
- The threshold for medication overuse headache varies by treatment, such as ≥15 days per month with NSAIDs or ≥10 days per month with triptans 1.
- Patients should be aware of the risks of medication overuse headache and the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, and managing stress with relaxation techniques or mindfulness practices 1. The most effective approach to managing NSMOD is to limit the use of NSAIDs and other acute medications, and to address underlying pain conditions through preventive therapies and lifestyle modifications. This approach can help to reduce the risk of medication overuse headache and improve overall outcomes for patients with NSMOD, as supported by the evidence from the American College of Physicians in 2025 1 and the Nature Reviews Neurology in 2021 1.
From the Research
Definition of NSMOD
- NSMOD stands for Non-Steroidal Medication Overuse Disorder, which is a type of medication overuse headache (MOH) caused by the overuse of non-steroidal anti-inflammatory drugs (NSAIDs) 2, 3.
- MOH is a subset of chronic daily headache that occurs from the overuse of one or more classes of migraine abortive medication, including NSAIDs, acetaminophen, combination analgesics, opioids, barbiturates, and triptans 2.
- The development of MOH, including NSMOD, is associated with both the frequency of use of medication and behavioral predispositions, and can lead to a decline in the quality of life, physical symptoms, and psychological distress 2.
Characteristics of NSMOD
- NSMOD is a challenging disorder that can cause daily and incapacitating headaches, insomnia, and non-restorative sleep, as well as psychological distress and reduced functioning 2.
- The risk of developing MOH, including NSMOD, is associated with the frequency and duration of NSAID use, particularly in patients with a high baseline headache frequency 3.
- However, NSAIDs may be protective against the development of MOH in patients with low to moderate baseline headache frequency 3.
Treatment and Prevention of NSMOD
- The treatment of MOH, including NSMOD, involves a combination of prophylactic pharmacotherapy, use of abortive medication with minimal risk of MOH, withholding previously overused medication, and providing psychological therapy 2.
- The prevention of NSMOD requires careful selection and use of NSAIDs, taking into account the patient's individual needs and risk factors, as well as regular monitoring and follow-up to prevent overuse and dependence 4, 3.