Adverse reactions related to drugs for headache treatment: clinical impact.
OBJECTIVE
To assess the clinical impact of adverse reactions related to drugs for primary headache treatment.


METHODS
We examined the adverse reactions to 360 medications prescribed by the specialists of the Headache Centre of the University of Modena and Reggio Emilia to 256 consecutive outpatients (214 female, 42 male; mean age: 38.88 +/- 14.06 years; range 10-72 years). Adverse reactions were reported by patients during scheduled follow-up visits, classified by specialists and reassessed by a clinical pharmacologist.


RESULTS
Adverse reactions with a causal relationship classified as definite/probable/possible were 202 (56%): 62% (80/129) were due to acute treatments and 53% (122/231) to prophylactic treatments (chi2 test, P = 0.115 ns). More than 90% of the adverse reactions were of limited intensity [mild (58%) or moderate (36%)]. Only 5% were severe, and two reactions (1%) were serious. The most affected apparatus was the nervous system (41%). Of these adverse reactions, 43% caused the discontinuance of the treatment, especially of prophylaxis (54%). Patients evaluated 70% of the medications as effective, but, at the same time, they considered most of the adverse reactions (69%) unacceptable.


CONCLUSIONS
Adverse reactions related to headache medications have a strong impact on patients' management, even if their real intensity and severity are usually very limited. Drugs for headache treatment are still far from being ideal drugs. To prevent the discontinuance of effective medications, the physician, prior to prescribing, should assess, together with the patient, the acceptability of the more common adverse drug reactions.
Ferrari
Anna
A
Division of Toxicology and Clinical Pharmacology, Headache Centre, University of Modena and Reggio Emilia, Policlinico, Largo del Pozzo, 71-41100 Modena, Italy. annaf@unimore.it
Ottani
Alessandra
A
Bertolini
Alfio
A
Cicero
Arrigo Francesco Giuseppe
AF
Coccia
Ciro Pio Rosario
CP
Leone
Sheila
S
Sternieri
Emilio
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002491:Central Nervous System Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D005260:Female; D020773:Headache Disorders / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged
D000700:Analgesics; D002317:Cardiovascular Agents; D002491:Central Nervous System Agents