Journal of Neurology

, Volume 236, Issue 1, pp 9–14

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

  • H.-C. Diener
  • J. Dichgans
  • E. Scholz
  • S. Geiselhart
  • W.-D. Gerber
  • A. Bille
Original Investigations

Summary

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.

Key words

Chronic headache Analgesics Withdrawal therapy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Abbott PJ (1986) Caffeine: a toxicological overview. Med J Aust 145:518–521Google Scholar
  2. 2.
    Ala-Hurula V, Myllylä V, Hokkanen E (1982) Ergotamine abuse: results of ergotamine discontinuation, with special reference to the plasma concentrations. Cephalalgia 2:189–195Google Scholar
  3. 3.
    Andersson PG (1975) Ergotamine headache. Headache 15:118–121Google Scholar
  4. 4.
    Bruyn GW (1985) Prevalence and incidence of migraine — a critical review. In: Carroll JD, Pfaffenrath V, Sjaastad O (eds) Migraine and beta-blockers. AB Hässle, Mölndal, pp 99–109Google Scholar
  5. 5.
    Dichgans J, Diener HC (1988) Clinical manifestations of excessive use of analgesic medication. In: Diener HC, Wilkinson M (eds) Drug induced headache. Springer, Berlin Heidelberg New York. pp 8–15Google Scholar
  6. 6.
    Dichgans J, Diener HC, Gerber WD, Verspohl EJ, Kukiolka H, Kluck M (1984) Analgetika-induzierter Dauerkopfschmerz. Dtsch Med Wochenschr 109:369–373Google Scholar
  7. 7.
    Diener HC, Bühler KU, Dichgans J, Geiselhart S, Gerber D, Scholz E (1988) Analgetikainduzierter Dauerkopfschmerz: Existiert eine kritische Dosis. Arzneimitteltherapie (in press)Google Scholar
  8. 8.
    Diener HC, Gerber WD, Geiselhart D, Dichgans J, Scholz E (1988) Short and long term effects of withdrawal therapy in drug induced headache. In: Diener HC, Wilkinson M (eds) Drug induced headache. Springer, Berlin Heidelberg New York, pp 133–142Google Scholar
  9. 9.
    Dige-Petersen H, Lassen NA, Noer J, Toennesen KH, Olesen J (1977) Subclinical ergotism. Lancet II:55–65Google Scholar
  10. 10.
    Fogelholm R, Murros K (1985) Maproptiline in chronic tension headache: a double blind cross-over study. Headache 25:273–275Google Scholar
  11. 11.
    Henry P, Dartigues JF, Benetier MP, Lucas J, Duplan B, Jogeix M, Orgogozo JM (1985) Ergotamine- and analgesic-induced headaches. In: Clifford Rose F (ed) Migraine. Proc 5th Int Migraine Symp London 1984. Karger, Basel, pp 197–205Google Scholar
  12. 12.
    Hokkanen E, Waltimo O, Kallanrata T (1978) Toxic effects of ergotamine used for migraine. Headache 18:95–98Google Scholar
  13. 13.
    Horton BT, Peters GA (1963) Clinical manifestations of excessive use of ergotamine preparations and management of withdrawal effect: report of 52 cases. Headache 3:214–226Google Scholar
  14. 14.
    Isler H (1982) Migraine treatment as a cause of chronic migraine. In: Clifford Rose F (ed) Advances in migraine research and therapy. Raven Press, New York, pp 159–164Google Scholar
  15. 15.
    Kudrow L (1982) Paradoxical effects of frequent analgesic use. In: Critchley M, Fridman AP, Gorinin S, Sicuteri F (eds) Advances in neurology, vol 33. Raven Press, New York, pp 335–341Google Scholar
  16. 16.
    Kudrow L (1988) Possible mechanisms and treatment of analgesic induced chronic headache. In: Diener HC, Wilkinson M (eds) Drug induced headache. Springer, Berlin Heidelberg New York, pp 157–161Google Scholar
  17. 17.
    Lance JW, Curran DA (1964) Treatment of chronic tension headache. Lancet I:1236–1239Google Scholar
  18. 18.
    Lippman CW (1955) Characteristic headache resulting from prolonged use of ergot derivatives. J Nerv Ment Dis 121:270–273Google Scholar
  19. 19.
    Lucas RN, Falkowski W (1973) Ergotamine and methysergide abuse in patients with migraine. Br J Psychiatry 122:199–203Google Scholar
  20. 20.
    Manzoni GC, Micieli G, Granella F, Sandrini G, Zanferrari C, Nappi G (1988) Therapeutic approach to drug abuse in headache patients. In: Diener HC, Wilkinson M (eds) Drug induced headache. Springer, Berlin Heidelberg New York, pp 143–149Google Scholar
  21. 21.
    Mathew NT (1988) Management of ergotamine withdrawal. In: Diener HC, Wilkinson M (eds) Drug induced headache. Springer, Berlin Heidelberg New York, pp 150–156Google Scholar
  22. 22.
    Medina J, Diamond S (1977) Drug dependency in patients with chronic headaches. Headache 17:12–14Google Scholar
  23. 23.
    Mörland TJ, Storli OV, Mogstad TE (1979) Doxepine in the prophylactic treatment of mixed „vascular“ and tension headache. Headache 19:382–383Google Scholar
  24. 24.
    Peatfield RC, Fozard JR, Clifford Rose F (1986) Drug treatment of migraine. In: Vinken PJ, Bruyn GW, Klawans HL, Clifford Rose F (eds) Handbook of clinical neurology, vol 48, revised series 4. Elsevier, Amsterdam, pp 173–216Google Scholar
  25. 25.
    Pradalier A, Dry S, Baron JF (1984) Cephalée induite par l'abuse de tartrate d'ergotamine chez les migrainieux. Concours Med 106:106–110Google Scholar
  26. 26.
    Rapaport A, Weeks R, Sheftell F (1985) Analgesic rebound headache: theoretical and practical implications. In: Olesen J, Tfelt-Hansen P, Jensen K (eds) Proceedings of the Second International Headache Congress, Copenhagen. Stougaard Jensen, Copenhagen, pp 448–449Google Scholar
  27. 27.
    Rowsell AR, Neylan C, Wilkinson M (1973) Ergotamine induced headaches in migrainous patients. Headache 13:65–67Google Scholar
  28. 28.
    Saper JR, Jones JM (1986) Ergotamine tartrate dependency: features and possible mechanisms. Clin Neuropharmacol 9:244–256Google Scholar
  29. 29.
    Scholz E, Diener HC, Geiselhart S (1988) Drug induced headache — does a critical dosis exist? In: Diener HC, Wilkinson M (eds) Drug induced headache. Springer, Berlin Heidelberg New York, pp 29–43Google Scholar
  30. 30.
    Tfelt-Hansen P, Krabbe AE (1981) Ergotamine abuse. Do patients benefit from withdrawal? Cephalalgia 1:29–32Google Scholar
  31. 31.
    Vanecek J (1984) Antipyretic analgesics. In: Dukes MNG (ed) Meyler's side effects of drugs. Elsevier, Amsterdam, pp 135–150Google Scholar
  32. 32.
    Verspohl EJ (1986) Migränemittel. In: Ammon HTP (ed) Arzneimittelneben-und Wechselwirkungen, 2nd edn. Wissenschaftliche Verlagsgesellschaft, Stuttgart, pp 318–328Google Scholar
  33. 33.
    Vrhovak B (1984) Anti-inflammatory analgesics and drugs used in gout. In: Dukes MNG (ed) Meyler's side effects of drugs, 10th edn. Elsevier, Amsterdam New York Oxford, pp 151–182Google Scholar
  34. 34.
    Wainscott G, Volans G, Wilkinson M (1974) Ergotamine induced headaches. Br Med J II:724Google Scholar
  35. 35.
    Wörz R (1983) Effects and risks of psychotropic and analgesic combinations. Am J Med 75:129–130Google Scholar
  36. 36.
    Wörz R, Baar H, Draf W, Garcia J, Gerbershagen HU, Gross D, Margin F, Ritter K, Scheifele J, Scholl W (1975) Kopfschmerz in Abhängigkeit von Analgetika-Mischpräparaten. Münch Med Wochenschr 117:457–462Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • H.-C. Diener
    • 1
  • J. Dichgans
    • 1
  • E. Scholz
    • 1
  • S. Geiselhart
    • 1
  • W.-D. Gerber
    • 3
  • A. Bille
    • 2
  1. 1.Department of NeurologyUniversity of TübingenTübingenFederal Republic of Germany
  2. 2.Department of NeuropsychologyUniversity of TübingenTübingenFederal Republic of Germany
  3. 3.Department of Medical PsychologyUniversity of KielKielFederal Republic of Germany
  4. 4.Neurologische KlinikEberhard-Karls-UniversitätTübingen 1Federal Republic of Germany

Personalised recommendations