One or several types of triptan overuse headaches?
BACKGROUND
Whereas the clinical features of pure triptan overuse headache (TOH) are well known, there are insufficient data regarding the semiological pattern of headaches when triptan overuse is associated with other types of medication overuse.


OBJECTIVE
To investigate and compare the clinical characteristics of patients with pure TOH and those with medication overuse headaches associating triptan and other medication overuses (combined TOH).


METHODS
This cross-sectional, observational study was conducted in 7 tertiary-care headache centers participating in the French Observatory of Migraine and Headaches. From 2004 to 2006, data from 163 patients with TOH were collected in face-to-face structured interviews (according to the International Classification of Headache Disorders, 2nd edition criteria).


RESULTS
Eighty-two patients fulfilled criteria for pure TOH (pTOH patients) and 81 for combined TOH (cTOH) patients. Continuous headaches were reported in 76% of cTOH patients compared with 32% of pTOH patients. Significantly more frequent and severe headaches and more intense phono-/photophobia between attacks were noted in cTOH patients. More cTOH than pTOH patients reported a history of tension-type headaches and a long-standing history of chronic headaches. Finally, compared with pTOH patients, cTOH patients were characterized by stronger dependence on acute treatments of headaches according to the DSM-IV criteria.


CONCLUSIONS
Combined therapy with analgesics and/or the total number of drug units taken per day may cause a shift from a pattern of clear-cut headache attacks in patients with pTOH toward more severe clinical presentation in patients with cTOH. These patients should receive more intensive prophylactic therapy and specific behavioral management.
Créac'h
Christelle
C
Department of Neurology, Saint-Etienne Hospital, Saint-Etienne University, INSERM U879, Saint-Etienne, France.
Radat
Francoise
F
Mick
Gerard
G
Guegan-Massardier
Evelyne
E
Giraud
Pierric
P
Guy
Nathalie
N
Fabre
Nelly
N
Nachit-Ouinekh
Fatima
F
Lanteri-Minet
Michel
M
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000145:classification* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019370:Observation; D012189:Retrospective Studies; D017366:Serotonin Receptor Agonists / Q000009:adverse effects*; D014363:Tryptamines / Q000009:adverse effects*; D055815:Young Adult
D017366:Serotonin Receptor Agonists; D014363:Tryptamines