A retrospective long-term analysis of the epidemiology and features of drug-induced headache

Drug-induced headache is well known to resul from the abuse of compounds ta ken for the treatment of primary headache. The features of drug-induced hea dache depend on various features including the availability of drugs, the r egional health system, and psychogenic factors of the patients. We performe d a retrospective study on a series of 257 consecutive German patients pres enting with drug-induced headache during the period 1983-1996. Our aim stud y was to evaluate the demographic features, the frequency of various drugs used, in particular of ergotamine derivates, and changes in these features during the study period. The frequency of drug-induced headache among all h eadache patients was 8%, with a female preponderance of 81%. Drug-induced h eadache occurred in all age,groups, predominantly in migraine patients (35% ). The mean number of substances used was 2.7, mainly, acetaminophen (47.9% ), ergotamine tartrate (45%), and combined analgesics (56%). We did not fin d a significant difference between the associations with ergotamine tartrat e and dihydroergotamine, although the latter was taken less frequently. Com paring the early and late years of our study period, there were no changes in the frequency of drug-induced headache (8% versus 7%), although changes in the frequency of some drugs changed (barbiturates, ergotamine tartrate, and codeine intake decreased whereas nonsteroidal anti-inflationary drugs, combined analgesics, and sumatriptan intake increased). Our data suggest th at changes in drug availability and the introduction of classification crit eria and treatment recommendations did not have a major impact on the frequ ency of drug-induced headache.