Drug-induced headache: Long-term follow-up of withdrawal therapy and persistence of drug misuse

Patients suffering from migraine, tension-type headache (TTH), or combined headache (CH) are at risk of developing drug-induced headache (DIH) due to regular use of analgesics, ergot alkaloids, and triptans. The aim of our st udy was to determine (1) the clinical features of DIH, (2) the outcome of w ithdrawal therapy using high methodological standards, and (3) predictors w hich could explain the high relapse rate (more than 40%) after a previously successful withdrawal therapy. We retrospectively reviewed 103 patients wi th migraine or TTH who underwent withdrawal therapy between 1994 and 1998. The long-term follow-up (2-4 years after therapy) was conducted by phone an d by specially trained psychologists using a structured interview which enc losed characteristics of headache and medication behavior as well as patien ts global assessment of success. Complete sets of data were available from 83 patients (38 migraine, 26 TTH, 19 CH). The most frequently abused drugs were caffeine-combined analgesics (24%), followed by caffeine-combined ergo tamines (19%), pure ergot alkaloids (17%), and monoanalgesics (17%). 48.5% of the patients suffered an abuse relapse within 4 years and developed the complete features of DIH again. Analgesic and ergot alkaloid combinations w ith caffeine lead significantly more often to a relapse. A long-term succes sful therapy is connected with a significant reduction of the frequency of headache attacks. Under relapse conditions, the patients reached their form er headache frequency level. The data show a higher relapse rate than previ ously assumed and that certain substance groups bear a higher relapse risk. Copyright (C) 2001 S. Karger AG, Basel.