Drug-induced headache: long-term results of stationary versus ambulatory withdrawal therapy

Drug-induced headache is a well-known complication of the treatment of prim ary headache disorders, and its successful management is only possible by w ithdrawal therapy. However, it is unknown whether ambulatory or stationary withdrawal is the therapy preferred. We conducted a prospective study on th e outcome of stationary versus ambulatory withdrawal therapy in patients wi th drug-induced headache according to the international Headache Society cr iteria. Out of 257 patients with the diagnosis of drug-induced headache dur ing the study period, 101 patients (41 after ambulatory and 60 after statio nary withdrawal therapy) could be followed up for 5.9+/-4.0 years. The tota l relapse rate after successful withdrawal therapy was 20.8% (14.6% after a mbulatory and 25.0% after stationary withdrawal therapy, p<0.2). The main r isk factors for a relapse were male sex (OR=3.9, CI=1.3-11.6), intake of co mbined analgesic drugs (OR=3.8, CT=1.4-10.3), administration of naturopathy (OR=6.0, CI=1.2-293), 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 antimigrai ne drugs has a major impact on the long-term result after successful withdr awal therapy. Patients with risk factors according to our findings should b e informed and monitored regularly, and combined drugs should be avoided. F urthermore, our data suggest that there is a need for research on individua l psychological and behavioral risk factors for relapse after successful wi thdrawal therapy in drug-induced headache.