title: [Daily chronic headache in patients with migraine induced by abuse of ergotamine-analgesics: response due to a protocol of outpatient treatment].
abstract: Chronic daily headache appears in migraine patients due to chronic consumption of analgesics-ergotamine. This entity was considered intractable without hospital admission. Our aim was to study the response of this headache to an outpatient treatment protocol. The therapeutic protocol included: 1. Oral information to the patient about the role of analgesics in the chronification of the headache; 2. Abrupt withdrawal of analgesics-ergotamine; 3. Administration of naproxen as symptomatic medication, and 4. Prophylactic treatment. After 2.5 months of treatment we evaluated both the frequency and the intensity of pain episodes as well as analgesic consumption. Thirty patients (8.6% of the outpatient consultations) suffered from chronic daily headache secondary to chronic analgesic abuse. Twenty five were females and 5 were males, their mean age +/- SD being 43 +/- 11 years. The mean +/- SD number of units of analgesics-ergotamine taken per week was 28 +/- 12. Three patients exclusively abused analgesics, the remainder either ergotamine, caffeine and various analgesics (18) or caffeine or several analgesics not containing ergotamine (9). In 29 patients the response was positive. Twenty (67%) showed an excellent improvement (> 75%) in frequency and intensity and completely gave up analgesics. The remaining nine (30%) improved moderately (50-75%). Only 3 patients in this group carried on taking analgesics. One patient showed no improvement. Our work confirms the epidemiological magnitude of chronic daily headache and shows that this is a treatable entity on an outpatient basis combining the abrupt withdrawal of analgesics-ergotamine, and their replacement by naproxen, with prophylactic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Departamento de Medicina y Psiquiatrìa, Hospital Universitario Marqués Valdecilla, Santander.
authors.forename: J
authors.initials: J
authors.lastname: Pascual
authors.forename: J
authors.initials: J
authors.lastname: Berciano
mesh_terms: D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000145:classification; D002908:Chronic Disease; D004878:Ergotamine / Q000009:adverse effects*; D005260:Female; D005444:Flunarizine / Q000008:administration & dosage / Q000627:therapeutic use; D006261:Headache / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008784:Methysergide / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009288:Naproxen / Q000627:therapeutic use; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009288:Naproxen; D011433:Propranolol; D004878:Ergotamine; D005444:Flunarizine; D008784:Methysergide
vernacular_title: Cefalea crónica diaria de pacientes migrañosos inducida por abuso de analgésicos-ergotamínicos: respuesta a un protocolo de tratamiento ambulatorio.