Sumatriptan and ergotamine overuse and drug-induced headache: A clinicoepidemiologic study

Drug-induced headache, particularly ergotamine-induced headache, is a commo n problem in migraine treatment. Some case reports suggest that even the ne w serotonergic antimigraine drugs such as sumatriptan can lead to overuse a nd subsequent drug-induced headache. We performed a controlled study to ide ntify the rate of sumatriptan overuse and sumatriptan-induced headache and compared it to the rate of ergotamine overuse and ergotamine-induced headac he. Two thousand sixty-five consecutive headache patients, all experienced in intake of sumatriptan (n = 631) or ergotamine (n = 620), were enrolled o ver a three-year study period. The rates of overuse and drug-induced headac he and the clinical features of the subgroups were compared. Risk factors f or sumatriptan overuse were identified. The rates of ergotamine and sumatri ptan overuse were 14.2% and 3.5%, respectively (p < 0.001). Drug-induced he adache could be found more frequently in cases of ergotamine overuse than i ncases of sumatriptan overuse (68% versus 32%; p < 0.01). Development of su matriptan overuse was most common in patients with previous drug-induced he adache (68%), combined headache as the primary headache type (45%), and sub cutaneous application of sumatriptan (45%). We conclude that sumatriptan in take can lead to overuse and subsequent drug-induced headache. The risk for overuse and drug-induced headache is significantly lower than in patients with ergotamine intake. This might be caused in part by the relatively shor t period of sumatriptan availability on the market. The new generation of s erotonin-1B/D-receptor agonists in the treatment of headache should have a potential for overuse similar to that of traditional headache drugs.