Treatment of chronic overmedicated headache patients.
The effective treatment for chronic headache with analgesic overuse is examined in this review. The first step of treatment is how to stop daily use of the analgesic, supporting the withdrawal syndrome and the worsening headache. In this phase there are different strategies from no treatment to antimigraine drugs. This step is followed by preventive antimigraine treatment sometimes followed or accompanied by antidepressant drug treatment. The most widely used drug in this class is amitriptyline [Tryptizol, Merck & Co, NY, USA. However, newer selective serotonin reuptake inhibitor antidepressants are also proposed. Unfortunately, few good clinical practice studies with long-term follow-up are available. In conclusion, there are no definite guidelines to treat these headaches and probably the main aim of the therapy for these patients should be to enable them to feel in control of their migraine, rather than feeling that migraine or analgesic drugs control them.
Pini
Luigi-Alberto
LA
Headache Study Center, Dept. of Internal Medicine, Clinical Pharmacology Unit, University of Modena and Reggio Emilia, Via del Pozzo, 71 41100 Modena, Italy. pinila@unimore.it
Bertolini
Alfio
A