Ergotamine and Methysergide Abuse in Patients with Migraine

Lucas, R. N.; Fałkowski, Wojciech

doi:10.1192/bjp.122.2.198

Cited by 25 publications

(13 citation statements)

References 13 publications

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“…All 24 patients admitted that the ergotamine tartrate had been prescribed initially for treatment of acute migraine attacks only, but the effective dose had increased gradually until eventually 22 (92%) of the patients were taking the drug daily. This phenomenon agrees with the findings of other authors, 13,14,15,16 and has been explained by the development of tolerance by the patients to ergotamine. Wolff 17 has recommended that the weekly dose of ergotamine tartrate should not exceed 10 mg per week; however, ethical pharmaceutical companies manufacturing ergotamine tartrate preparations differ in their advice, variously recommending maximum weekly doses of 10, 12 and 24 mg. 18 Table 3 is a summary of the patients taking these recommended dosages.…”

Section: Discussionsupporting

confidence: 93%

“…8,9,10,11,12 However Peters and Horton, 13 Silverskiold,14 Friedman, Brazil and von Storch, 15 and more recently Lucas and Falkowski 16 have reported the occurrence of tolerance and increased frequency of headaches in some patients taking frequent doses of ergotamine tartrate. These same authors 13,14,15,16 have also reported that such patients can experience withdrawal headaches on discontinuance of the drug.A marked increase in the frequency of the headaches was noted by the 24 patients included in this study whilst taking regular doses of ergotamine tartrate. Withdrawal of the drug was associated with resolution of the symptoms.…”

mentioning

confidence: 90%

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Ergotamine Induced Headaches in Migrainous Patients

Bowseli¹,

Neylan²,

Wilkinson³

1973

Headache

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 90%

Ergotamine Induced Headaches in Migrainous Patients

Bowseli¹,

Neylan²,

Wilkinson³

1973

Headache

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“…As reported in other studies, our patients showed all characteristics of physical and emotional dependence and had distinct psychological features with tendencies to overreact and depressive mood disturbances. 3,14 The pathophysiological mechanisms underlying drug-induced headaches and rebound headaches involve vascular and muscular mechanisms as well as disturbances of the endorphin system. 2,3,6,9,23 Drug-induced headaches were originally thought to be caused exclusively by the ergotamine components of pain relievers, 8,[10][11][12][13][14][15] several recent studies, however, have shown the occurrence of drug-induced headache without the use of ergotamine.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Originally, drug-induced headaches were thought to be caused by ergotamine components of pain relievers and therefore termed ergotamine headaches. 8,[10][11][12][13][14][15] Recent studies, however, have shown that a similar form of headache is caused by chronic use of analgesics without ergotamine components and therefore the terms analgesic-induced or drug-induced headaches should be preferred. 2,3,7,9,16 Drug-induced headaches are a common problem as 10-15% of the patients in headache clinics, and about 1% of the population in general suffer from this type of headache.…”

Section: Introductionmentioning

confidence: 99%

Longterm Prognosis of Analgesic Withdrawal in Patients with Drug‐Induced Headaches

Baumgartner¹,

Wessely²,

Bingöl³

et al. 1989

Headache

134

106

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We studied long-term prognosis and prognostic variables for therapeutic outcome of analgesic withdrawal in 54 patients with drug-induced headaches. The duration of headache history was 21.9 +/- 12.8 years. Each patient took an average of 38.8 +/- 22.8 tablets or suppositories a week and an average of 2.5 distinct drugs. Most patients used drugs containing several components. Caffeine was contained in at least one drug in all cases, ergotamine in 80.0% and pyrazolone in 77.1%. All patients were admitted to the hospital for two weeks. The analgesics were discontinued abruptly and the withdrawal symptoms were alleviated by neuroleptics and neurotropics. During the second week of hospital stay we started a basic therapy with calcium antagonists or beta blockers in patients suffering from migraine initially and with tricyclic antidepressants, physical therapy or biofeedback in patients suffering from tension type headaches initially. At the end of the study (mean follow-up period = 16.8 +/- 13.6 months) 38 patients (70.1%) were evaluated. 76.3% of these patients had significantly reduced their analgesic intake, 60.5% had experienced a significant relief of headache both in intensity and frequency, and 23.7% were therapeutic failures. Analysis of the time course of relapse revealed the first six months after hospital discharge as the critical period determining long-term success. The variables tested for prognostic relevance (age, sex, duration of headache history, number of tablets or suppositories taken a week, organic mental syndrome, and type of initial headaches) were not statistically significant.

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“…However, in later studies it was realized that also the chronic abuse of analgesics and other psycho tropic drugs could lead to drug-induced daily headache and that only consequent withdrawal therapy was able to reduce headache frequency and intensity (3)(4)(5)(6)(7)(8)(9)(10). In the first observations on chronic drug-induced headache, only ergotamine was assumed to cause this phenomenon (1, 2).…”

mentioning

confidence: 99%

Drug-Induced Headache: Long-Term Results of Stationary Versus Ambulatory Withdrawal Therapy

Suhr¹,

Evers²,

Bauer

et al. 1999

Cephalalgia

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Drug-induced headache is a well-known complication of the treatment of primary headache disorders, and its successful management is only possible by withdrawal therapy. However, it is unknown whether ambulatory or stationary withdrawal is the therapy preferred. We conducted a prospective study on the outcome of stationary versus ambulatory withdrawal therapy in patients with drug-induced headache according to the International Headache Society criteria. Out of 257 patients with the diagnosis of drug-induced headache during the study period, 101 patients (41 after ambulatory and 60 after stationary withdrawal therapy) could be followed up for 5.9 +/- 4.0 years. The total relapse rate after successful withdrawal therapy was 20.8% (14.6% after ambulatory and 25.0% after stationary withdrawal therapy, p < 0.2). The main risk factors for a relapse were male sex (OR = 3.9, CI = 1.3-11.6), intake of combined analgesic drugs (OR = 3.8, CI = 1.4-10.3), administration of naturopathy (OR = 6.0, CI = 1.2-29.3), and a trend to tension-type headache as the primary headache disorder (OR = 1.9, CI = 0.6-53.0). Our data suggest that neither the method of withdrawal therapy nor the kind of analgesic and other antimigraine drugs has a major impact on the long-term result after successful withdrawal therapy. Patients with risk factors according to our findings should be informed and monitored regularly, and combined drugs should be avoided. Furthermore, our data suggest that there is a need for research on individual psychological and behavioral risk factors for relapse after successful withdrawal therapy in drug-induced headache.

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Ergotamine and Methysergide Abuse in Patients with Migraine

Cited by 25 publications

References 13 publications

Ergotamine Induced Headaches in Migrainous Patients

Ergotamine Induced Headaches in Migrainous Patients

Longterm Prognosis of Analgesic Withdrawal in Patients with Drug‐Induced Headaches

Drug-Induced Headache: Long-Term Results of Stationary Versus Ambulatory Withdrawal Therapy

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