Clinical features of withdrawal headache following overuse of triptans and other headache drugs.
BACKGROUND
Complete withdrawal from headache medication is the treatment of choice for medication-overuse headache. Discontinuation of the overused headache medication, however, results in the development of withdrawal headache, often associated with nausea, vomiting, and sleep disturbances.


METHODS
In a prospective study of 95 patients, the authors investigated the duration and severity of withdrawal headache after overuse of various headache drugs, including single and combination analgesics, ergots, and triptans. All patients underwent standard inpatient withdrawal therapy for 14 days.


RESULTS
The duration of withdrawal headache was shorter in patients overusing triptans (4.1 days) than in patients overusing ergots (6.7 days) or analgesics (9.5 days; p < 0.002). The mean headache intensity on the first day of withdrawal did not differ between the groups (p = 0.821). By day 14, however, it was lower in patients overusing triptans (0.08) than in patients overusing ergots (0.4) or analgesics (0.9; p < 0.005). Rescue medication was requested less by patients undergoing triptan withdrawal (0.25 requests) than by patients undergoing ergot withdrawal (1.25) or analgesic withdrawal (1.85; p < 0.05). Similar to findings in the entire patient population, withdrawal headache was shorter and less severe in migraineurs overusing triptans than in those overusing ergots or analgesics. Because only patients with migraine, but no patient with tension-type headache, overused triptans, withdrawal headache was shorter in the group of patients with migraine alone (6.7 days versus 9.6 days for patients with tension-type headache and 8.5 days for patients with combination headache, p < 0.02).


CONCLUSIONS
The duration and severity of withdrawal clearly depend on the type of overused headache drug only.
Katsarava
Z
Z
Department of Neurology, University Hospital Essen, Germany.
Fritsche
G
G
Muessig
M
M
Diener
H C
HC
Limmroth
V
V
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D004878:Ergotamine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000008:administration & dosage / Q000009:adverse effects; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*; D018170:Sumatriptan / Q000008:administration & dosage / Q000009:adverse effects*; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects; D014363:Tryptamines; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
D000700:Analgesics; D007211:Indoles; D023303:Oxazolidinones; D010880:Piperidines; D014230:Triazoles; D014363:Tryptamines; D014662:Vasoconstrictor Agents; C089750:zolmitriptan; C093622:rizatriptan; D018170:Sumatriptan; D004878:Ergotamine; C106783:naratriptan