Too Much Medication

OB/GYN News, April 15, 2000 by Sally Koch Kubetin

Medications to relieve headache pain, when used too often, can contribute to the development and maintenance of the headaches, Dr. Stephen D. Silberstein said at a meeting on treating the difficult headache patient.

Overuse of agents such as analgesics, opiates, ergoramine, and the triptans also can make headaches refractory to preventive medication, added Dr. Silberstein of Thomas Jefferson University in Philadelphia.

About 4% of the U.S. population have chronic daily headaches--headaches that last at least 4 hours at least half the days of the month.

Between 60% and 90% of patients with chronic daily headache overuse acute medications, he maintained at the meeting sponsored by the Diamond Headache Clinic.

To break the headache cycle in patients with chronic daily headache and overuse of medications, first prescribe preventive agents. These include b-blockers, antidepressants, or select anticonvulsants. Next, discontinue or limit the acute agents, he advised.

Behavioral therapies can help. These include biofeedback, assumption of regular eating and sleeping habits, smoking cessation, physical therapy, and aerobic exercise.

Withdrawal symptoms, including an increase in headaches, nausea, and even seizures, may persist for 2-4 weeks. Hospitalization may be required in patients with severe headache exacerbations or seizures during detoxification.

But after the withdrawal period, the headaches will frequently improve, Dr. Silberstein said.