Favorable response to analgesics does not predict a benign etiology of headache.
BACKGROUND
Distinguishing between primary and secondary headaches (HAs) is essential for the safe and effective management of patients with HA. A favorable response to analgesics may be observed with both classes of HAs and therefore is not a good predictor of who needs further evaluation.


OBJECTIVE
To systematically review the data that a favorable response to analgesics including triptans should not be used to exclude a serious secondary cause of HA.


METHODS
PubMed search of English-language articles between 1980 and 2007 and reference lists of these articles. Two authors independently reviewed articles for study results and quality. Inclusion was based on 100% agreement between authors. We included articles that described secondary HAs as (1) having a favorable response to analgesics and/or (2) having a favorable response to sumatriptan. Of the 548 studies identified by our search strategy, 18 were included in our final analysis.


RESULTS
Seven of the 18 studies found that 46/103 patients (44%) described a significant or complete resolution of secondary HA from medications such as anti-emetics and nonsteroidal anti-inflammatory drugs (NSAIDs). Eleven of the 18 articles including 25/25 patients (100%) described a significant or complete resolution of secondary HA from sumatriptan, a serotonin 5HT agonist.


CONCLUSIONS
A favorable response to analgesics including triptans should not be used to exclude a serious secondary cause of HA.
Pope
Jennifer V
JV
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Edlow
Jonathan A
JA
D000700:Analgesics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D006261:Headache / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D018170:Sumatriptan / Q000627:therapeutic use; D016896:Treatment Outcome
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D017366:Serotonin Receptor Agonists; D018170:Sumatriptan