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

Baumgartner, Christoph; Wessely, P; Bingöl, Cicek; Maly, Joachim; Holzner, F

doi:10.1111/j.1526-4610.1989.hed2908510.x

Cited by 134 publications

(122 citation statements)

References 13 publications

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“…Some results of this study concerning the clinical features of DIH, the relapse rate, and the prediction of relapse (see above) deviate from formerly described data [6, 7, 9, 10, 11]. Differences in methods may contribute to this effect.…”

Section: Discussioncontrasting

confidence: 46%

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Drug-Induced Headache: Long-Term Follow-Up of Withdrawal Therapy and Persistence of Drug Misuse

Fritsche¹,

Eberl²,

Katsarava³

et al. 2001

Eur Neurol

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Patients suffering from migraine, tension-type headache (TTH), or combined headache (CH) are at risk of developing drug-induced headache (DIH) due to regular use of analgesics, ergot alkaloids, and triptans. The aim of our study was to determine (1) the clinical features of DIH, (2) the outcome of withdrawal therapy using high methodological standards, and (3) predictors which could explain the high relapse rate (more than 40%) after a previously successful withdrawal therapy. We retrospectively reviewed 103 patients with migraine or TTH who underwent withdrawal therapy between 1994 and 1998. The long-term follow-up (2–4 years after therapy) was conducted by phone and by specially trained psychologists using a structured interview which enclosed characteristics of headache and medication behavior as well as patients global assessment of success. Complete sets of data were available from 83 patients (38 migraine, 26 TTH, 19 CH). The most frequently abused drugs were caffeine-combined analgesics (24%), followed by caffeine-combined ergotamines (19%), pure ergot alkaloids (17%), and monoanalgesics (17%). 48.5% of the patients suffered an abuse relapse within 4 years and developed the complete features of DIH again. Analgesic and ergot alkaloid combinations with caffeine lead significantly more often to a relapse. A long-term successful therapy is connected with a significant reduction of the frequency of headache attacks. Under relapse conditions, the patients reached their former headache frequency level. The data show a higher relapse rate than previously assumed and that certain substance groups bear a higher relapse risk.

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Section: Discussioncontrasting

confidence: 46%

“…While a meta-analysis (29 studies) has been published investigating the first aspect [3], only five studies refer to the second and third aspects [6, 7, 9, 10, 11]. Sufficient relevance to the current situation can only be seen in the studies performed by Suhr et al [9]and Schnider et al [11].…”

Section: Introductionmentioning

confidence: 95%

Drug-Induced Headache: Long-Term Follow-Up of Withdrawal Therapy and Persistence of Drug Misuse

Fritsche¹,

Eberl²,

Katsarava³

et al. 2001

Eur Neurol

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“…Although only preliminary, our data are in accordance with previous observations [13] and are encouraging for the use of the protocol. The differences in HI and DDI before and after treatment are highly significant.…”

Section: Discussionsupporting

confidence: 82%

Preliminary results of a withdrawal and detoxification therapeutic regimen in patients with probable chronic migraine and probable medication overuse headache

Trucco

Meineri²,

Ruiz

2005

J Headache Pain

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Chronic migraine (CM) is an invalidating condition affecting a significant population of headache sufferers, frequently associated with medication overuse headache (MOH). Controlled trials and guidelines for the treatment of MOH are currently not available. We studied the efficacy of a therapeutic regimen for the withdrawal of the overused drug and detoxification in a sample of patients suffering from probable CM and probable MOH during admission in eight hospitals of Piemonte–Liguria–Valle d’Aosta. Fifty patients, 42 females (84%) and 8 males (16%), mean age at observation 50.66±13.08 years, affected by probable CM and daily medication overuse following IHS diagnostic criteria were treated as inpatients or in a day hospital. Headache index (HI) and daily drug intake (DDI) were used for evaluating the severity of headache and medication overuse. The patients were treated by abrupt discontinuation of the overused drug and by a therapeutic protocol including i.v. hydration, dexamethasone, metoclopramide and benzodiazepines for 7–10 days. Prophylactic medication was started immediately after admission. Analgesics or triptans were used under medical control only in cases of severe rebound headache. Diagnostic protocol included routine blood tests (at admission and at discharge), dosage of B12 and folic acid. Patients underwent follow-up controls one, three and six months after discharge. The initial diagnosis was probable CM in almost all patients included in the study (41 patients); in nine patients the diagnosis was not specified (coded only as CDH). The overused medications were simple analgesics in 17 cases (34%), combination analgesics in 19 cases (38%), triptans alone or with analgesics in 13 cases (26%) and ergotamine in 2 cases (4%). We collected data from 39 patients at first follow–up (1 month), 32 after 3 months and 14 after 6 months. Mean HI was 0.91 at admission, 0.22 at discharge, 0.38 after 30 days, 0.46 after 3 months and 0.48 after 6 months. Mean DDI was 2.80 at admission, 0.39 at discharge, 0.41 after 1 month, 0.52 after 3 months and 0.59 after 6 months. These results are on average positive and tend to remain stable with time. Although preliminary and obtained on a limited number of patients at 6–month follow–up, our results seem to be encouraging about the use of the proposed therapeutic protocol.

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“…On the other hand, others did not find any significant prognostic factor for long-term outcome in CDH patients [32,33].…”

Section: Discussionmentioning

confidence: 99%

Chronic daily headache: how to manage it?

Pini¹

2003

J Headache Pain

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The role of daily analgesic use (also called abuse) in chronic daily headache (CDH) for the maintenance of chronic headache is discussed. The comprehension of the underlying mechanisms of actions is lacking mainly because of the absence of animal models. The abuse should be considered as a compulsive behavior rather than linked to the type of analgesic used and related both to "how" the drug is taken and to "what" drug is used. Moreover, there is no evidence of addictive personality in these patients, and also predictive factors for the long-term outcomes are inconsistent. In the literature specific indications are lacking for the treatment to be performed in these patients. In conclusion, the main problem for these patients is to manage their headaches, and the aim of the therapy should be to enable patients to feel in control of their migraine rather than feel that migraine or analgesic drugs control them.

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

Cited by 134 publications

References 13 publications

Drug-Induced Headache: Long-Term Follow-Up of Withdrawal Therapy and Persistence of Drug Misuse

Drug-Induced Headache: Long-Term Follow-Up of Withdrawal Therapy and Persistence of Drug Misuse

Preliminary results of a withdrawal and detoxification therapeutic regimen in patients with probable chronic migraine and probable medication overuse headache

Chronic daily headache: how to manage it?

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