Development of Tolerance to Ergot Alkaloids in a Patient with Unusually Severe Migraine

Analgesic Overuse Is A Cause of Chronic Daily Headache

“…Discontinuation of the offending SM(s) consistently results in a withdrawal syndrome. 1,2,4,9,12,22,23 …”

“…The development of headache consequent to drug overuse was first proposed over 60 years ago, when Dreisbach suggested that caffeine could cause both chemical dependence and withdrawal headaches upon cessation 1 . In 1949, two groups reported that ergotamine tartrate similarly was associated with dependence and withdrawal headaches, adding that increased headache frequency could result from active overuse of that agent 2,3 . Peters and Horton subsequently suggested the term rebound headache for this condition and postulated ergotamine‐induced vasoconstriction/headache relief and subsequent withdrawal vasodilation/headache recurrence as its cause 4 .…”

Does Chronic Daily Headache Arise De Novo in Association With Regular Use of Analgesics?

“…The overuse of specific acute antimigraine medications, ergotamine, and triptans, (5‐HT 1B/1D agonists), has attracted some attention over the last decade. The problem of rebound headache associated with ergotamine overuse is not new 9‐12 . Why some patients are more prone to develop overuse and daily headache than others is unclear 13 .…”

Ergotamine Induced Headaches in Migrainous Patients

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SINCE ITS FIRST reported use in the treatment of migraine by Maier 1 in 1926, ergotamine tartrate has become widely used in the treatment of this condition, and approximately 80% 2 of patients can be expected to respond to the drug.Serious side effects including circulatory disorders are uncommon when ergotamine tartrate is used in the treatment of migraine, 3,4,5,6,7 but well documented. 8,9,10,11,12 However Peters and Horton, 13 Silverskiold,14 Friedman, Brazil and von Storch, 15 and more recently Lucas and Falkowski 16 have reported the occurrence of tolerance and increased frequency of headaches in some patients taking frequent doses of ergotamine tartrate. These same authors 13,14,15,16 have also reported that such patients can experience withdrawal headaches on discontinuance of the drug.A marked increase in the frequency of the headaches was noted by the 24 patients included in this study whilst taking regular doses of ergotamine tartrate.

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