Relevance of analgesic abuse in the maintenance of chronic headaches

Headache Induced by Chronic Substance Use: Analysis of Medication Overused and Minimum Dose Required to Induce Headache

“…Many studies have shown that triptan overuse may transform an episodic headache into a chronic headache 21–26 . The results of this study are in agreement with these observations and suggest that triptans should be included in group 8 of the IHS classification at level 8.2.3.…”

Behavioral and Pharmacologic Treatment of Transformed Migraine With Analgesic Overuse: Outcome at 3 Years

“…In most cases, patients with drug‐aggravated headache have a history of episodic migraine that has transformed into chronic daily headache (CDH): transformed migraine. 3,4,15 The pathophysiological mechanisms underlying drug‐induced headache are probably related to vascular and muscular mechanisms as well as to disturbances of central modulation of pain 15‐19 . Patients who are overusing symptomatic medication must be withdrawn from the offending medication before their headaches can be treated effectively 8,13,20,21 .…”

“…3,4,15 The pathophysiological mechanisms underlying druginduced headache are probably related to vascular and muscular mechanisms as well as to disturbances of central modulation of pain. [15][16][17][18][19] Patients who are overusing symptomatic medication must be withdrawn from the offending medication before their headaches can be treated effectively. 8,13,20,21 Sustained improvement following treatment for drug-induced headache may be difficult to achieve.…”

Preface

“…Palagini et al reviewed studies concerning psychiatric and psychopathological comorbidity of headache and supporting the hypothesis of a psychoneurobiological loop as the principal mechanism of chronic evolution of headache [6]. The relevance of analgesic abuse in the maintainance of chronic headache was analysed by Pini and Relja [7]. The supplement continues with research reports, starting with the paper of Granella et al [8] on the clinical interview used for data collection and the description of the case series.…”