title: One or several types of triptan overuse headaches?
abstract: 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.
authors.affiliation: Department of Neurology, Saint-Etienne Hospital, Saint-Etienne University, INSERM U879, Saint-Etienne, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Créac'h
authors.forename: Francoise
authors.initials: F
authors.lastname: Radat
authors.forename: Gerard
authors.initials: G
authors.lastname: Mick
authors.forename: Evelyne
authors.initials: E
authors.lastname: Guegan-Massardier
authors.forename: Pierric
authors.initials: P
authors.lastname: Giraud
authors.forename: Nathalie
authors.initials: N
authors.lastname: Guy
authors.forename: Nelly
authors.initials: N
authors.lastname: Fabre
authors.forename: Fatima
authors.initials: F
authors.lastname: Nachit-Ouinekh
authors.forename: Michel
authors.initials: M
authors.lastname: Lanteri-Minet
mesh_terms: 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
chemical_list: D017366:Serotonin Receptor Agonists; D014363:Tryptamines