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).