ANALGESIC REBOUND HEADACHE IN CLINICAL-PRACTICE - DATA FROM A PHYSICIAN SURVEY

Background: Frequent, excessive use of over-the-counter or prescriptio n analgesics may lead to analgesic rebound headache. Little is known a bout the magnitude of the health problem posed by analgesic rebound he adache, its epidemiology, the characteristics of analgesic rebound hea dache sufferers, or about physicians' approaches to treatment. Methods : Four hundred seventy-three practitioners, who had previously express ed an interest in the treatment of headache, were mailed a questionnai re designed to capture information about the frequency and management of analgesic rebound headache and about the characteristics of analges ic rebound headache sufferers. Results: Completed questionnaires were returned by 174 practitioners (37%) from 40 states, the District of Co lumbia, and Puerto Rico. More than 40% of respondents indicated that a nalgesic rebound headache was present in at least 20% of their patient s. On average, the physicians reported that 73% of patients with analg esic rebound headache were women. Analgesic rebound headache was most likely to occur in patients aged 31 to 40 years. No one analgesic was consistently identified as causative, although acetaminophen, butalbit al + aspirin + caffeine, and aspirin were commonly used by patients. E ighty percent of respondents indicated that depression was commonly ob served in analgesic rebound headache sufferers; 77% indicated that phy sical conditions (especially gastrointestinal symptoms) were commonly observed. A variety of therapeutic strategies, including pharmacothera py, were used in the management of analgesic rebound headache. Conclus ion: Analgesic rebound headache was recognized as a distinct entity an d a substantive component in more than 40% of the practices of 174 sur veyed practitioners. General practitioners, who see a wide variety of patient types with a spectrum of complaints, need to be able to diagno se analgesic rebound headache by taking a good history.