Analgesic Combination in Headache

Abstract

A RECENT double-blind study demonstrated that the combination of orphenadrine citrate and APC had analgesic properties significantly superior to either of its component parts, which were each superior to a placebo. 1 A second double-blind study reported orphenadrine-APC to be superior to A previous report on the use of muscle relaxants in the treatment of headache, published in July, 1961, indicated extremely promising results with orphenadrine citrate (Norflex (R) ) in a variety of headache problems. 2 Results were satisfactory in approximately 80 per cent of patients with tension headaches, arthritic involvement of the cervical spine, as well as post traumatic headaches, whereas treatment was singularly ineffective in patients with vascular headaches of the migraine and histaminic cephalalgia variety. The very satisfactory results achieved in the treatment of backache were analogous to those achieved in tension and traumatic headache, since many of the dynamic factors applicable in the genesis of neck pain were present likewise in patients with backache.Some little inflexibility in dosage utilization of orphenadrine citrate was encountered since the average dose was 100 mg. twice a day and smaller amounts were required at times in order to minimize occasional side effects. Most patients were also using analgesics of the salicylate variety and it seemed most logical to incorporate standard doses of APC compound with 25 mg. of orphenadrine, then a flexible dosage schedule of 1 or 2 tablets at intervals of 2 to 4 times a day would be available to render satisfactory analgesia. There is ample evidence of the value of this type of combination in the literature.Our experience likewise indicated that certain classes of disorders would he most responsive to this combination of drugs. Accordingly, patients with severe pain, associated with vascular headache, were excluded, as were those patients in whom the mechanism of pain was not clearly understood, such as cases of trigeminal neuralgia and headache associated with severe depression or hysteria. The pharmacological considerations of the action of orphenadrine have been reported in our previous publication.Each patient in this study was evaluated, as previously described, including thorough history and physical examination, as well as appropriate laboratory and x-ray studies. The groups of patients selected for this study included patients with tension headache, cervical strain, cervical dic, cervical arthritis and acute torti-