3. DISCUSSION
The headache in this case had multiple causes associated with the treatment of MG, such as IVIg. However, during the medical interview, long-term use of analgesics was revealed, and evaluation by an acupuncturist based on the ICHD-3 criteria suggested MOH. Though the headache diary was not able to assess the number of days of headache at baseline, she had headaches for 15 days or more before acupuncture. Therefore, we suspected MOH and advised acupuncture, which not only improved the headache, but also reduced loxoprofen use.
The acupuncturist was able to elicit OTC analgesics use. This may be due to a good rapport established between the patient and the acupuncturist because of the relatively prolonged contact with the patient during the medical interview, physical examination, and treatment. Patients with MOH should refrain from taking analgesics as much as possible.6 Intervention by an acupuncturist in the treatment of MOH in this case was successful with explanations for headache relief and medication compliance. This case suggests that acupuncturists who have knowledge of the ICHD-3, which includes MOH, may play a role as part of the medical management teams rather than solely providing acupuncture to relieve pain.
In conclusion, the improvement of headache in a patient with MOH suggests that intervention by acupuncturists may be a non-pharmacological treatment option for MOH. The participation of acupuncturists with knowledge of ICHD-3 in medical teams may contribute to headache relief and proper substance use.
Patient perspective
Before acupuncture treatment, the patient did not understand MOH correctly. Her contact with an acupuncturist with knowledge of ICHD-3 facilitated her understanding of the pathology of MOH. In addition, acupuncture reduced headaches and succeeded in reducing the use of OTC analgesics. She claims that her lengthy conversations and treatments with the acupuncturist were helpful in correctly recognizing her own headaches (June 2021).