Amitriptyline and dexamethasone combined treatment in drug-induced headache.
Frequent or regular intake of antimigraine drugs, including analgesics, constitutes a common cause of chronic daily headache. Discontinuation of symptomatic medication can produce an increase in head pain accompanied by withdrawal symptoms. We report the favourable outcome of treating a group of outpatients with the combination of amitriptyline, dexamethasone and sumatriptan. Dexamethasone (4 mg/day) was given intramuscularly for 2 weeks, amitriptyline orally at night (50 mg/day) for at least 6 months, and sumatriptan subcutaneously to treat acute headache attacks. Eighteen out of 20 patients abstained from drug abuse. Eleven of these 18 patients showed a marked reduction in headache frequency (at least 75% in relation to the basal value), and were considered "very good responders". The other seven patients experienced at least 50% reduction in headache frequency compared to baseline. This preliminary report suggests that drug-induced headache can be treated effectively in outpatients using dexamethasone, amitriptyline and sumatriptan in combination with significant benefit in everyday life conditions.
Bonuccelli
U
U
Institute of Clinical Neurology, University of Pisa, Italy.
Nuti
A
A
Lucetti
C
C
Pavese
N
N
Dell'Agnello
G
G
Muratorio
A
A
D000328:Adult; D000639:Amitriptyline / Q000627:therapeutic use*; D000700:Analgesics / Q000009:adverse effects*; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006261:Headache / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome; D018170:Sumatriptan / Q000627:therapeutic use*; D016896:Treatment Outcome
D000700:Analgesics; D000639:Amitriptyline; D003907:Dexamethasone; D018170:Sumatriptan