Medication-induced headache: Overview and systematic review of therapeuticapproaches

OBJECTIVE: To review medication-induced headache (MIH) through a systematic evaluation of the literature regarding the pharmacologic management of thi s condition. METHODOLOGY: TO identify and evaluate all pharmacologic interventions for M IH, we conducted a qualitative systematic review of the English-language li terature from 1966 to June 1998 using MEDLINE. The following search terms w ere used: chronic daily headache, transformed migraine, analgesic withdrawa l headache, analgesic rebound headache, drug-associated headache, medicatio n-induced headache, detoxification, and dihydroergotamine. In addition, a r eview of the references from relevant literature was also conducted to coll ect reports not identified in the MEDLINE search. RESULTS: Numerous therapies for acute management of MM have been evaluated, although no rigorously conducted clinical trials were identified. Therapie s evaluated include abrupt withdrawal of analgesics, initiation of dihydroe rgotamine, nonsteroidal antiinflammatory agents, methylergonovine, dihydroe rgotamine, sumatriptan, amitriptyline, dexamethasone, piracetam, prothipend yl, and valproate. Epidemiology, diagnosis, clinical features, pathophysiol ogy, and long-term prognosis of therapy are discussed and therapeutic guide lines are offered, CONCLUSIONS: MIH is an underrecognized and difficult condition affecting he adache-prone patients. The published literature concerning treatment of pat ients with MIH is scant and of poor quality, making it difficult for clinic ians to decide on appropriate therapy. Recognition and treatment of MIH may lead to a long-term improvement in headache relief fur many patients. It a ppears that complete withdrawal of the medications being overused is requir ed for favorable long-term results.