Analgesic-induced chronic headache: long-term results of withdrawal therapy

Abstract

Headache characteristics are described in 139 patients with chronic daily or almost daily headaches due to regular intake of analgesics and the short- and long-term results of drug withdrawal. Drug-induced headache was described as dull, diffuse, and band-like, and usually started in the early morning. The mean duration of the original headache (migraine or tension headache) was 25 years; regular intake of drugs and chronic daily headache had started 10 and 6 years prior to withdrawal therapy, respectively. Patients took an average of 34.6 tablets or analgesic suppositories or antimigraine drugs per week containing 5.8 different substances. The drugs most often used were caffeine (95%), ergotalkaloids (89%), barbiturates (64%), and spasmolytics, paracetamol, and pyrazolone derivates (45%-46%). A total of 103 patients (68 migraine, 35 tension or combination headache) were available for interviews at a mean time interval of 2.9 years after an inpatient drug withdrawal programme. Chronic headache had disappeared or was reduced by more than 50% in two-thirds of the patients. Positive predictors for successful treatment were migraine as primary headache, chronic headache lasting less than 10 years, and regular intake of ergotamine. Drug intake was significantly reduced and patients used single substances more often. Patients who originally suffered from migraine, superimposed on the daily headache, also experienced a significant improvement in the frequency of the migraines and their intensity. Migraine prophylaxis through beta-blocking agents and calcium channel antagonists was more efficient after drug-withdrawal therapy.

Relevance of analgesic abuse in the maintenance of chronic headaches

“…Epidemiology, diagnosis, clinical features, pathophysiology, and longterm prognosis of therapy were discussed and therapeutic guidelines were offered. Serotonin agonists for the treatment of chronic daily headaches have been studied and some positive results have been obtained in follow-ups lasting some months [28,29].…”

Chronic daily headache: how to manage it?

“…The duration of chronic drug overuse was found by some authors to be a significant parameter [27][28][29]; for example, the type of analgesic abused was relevant in maintaining CDH and drug abuse [29][30][31]. On the other hand, others did not find any significant prognostic factor for long-term outcome in CDH patients [32,33].…”

Headache, Primary Headaches and Their Treatment

“…Drug rebound headache is more common when using ergotamines, narcotics, and products that combine caffeine with aspirin or acetaminophen. 33,34 Even patients who take as little as 1000 mg per day of aspirin or acetaminophen may develop drug rebound headache. 35 Many clinicians believe that the frequency of use is most important, and they limit the use of all symptomatic medication to two days a week.…”