Withdrawal Therapy Improves Chronic Daily Headache Associated with Long-Term Misuse of Headache Medication: A Retrospective Study

Abstract

Chronic daily headache (CDH) associated with long-term misuse of headache medication is a common clinical problem which is refractory to most treatments. The present study is a retrospective analysis of the effect of drug withdrawal therapy in patients with CDH and frequent long-term use of headache symptomatic medication. One hundred and one adult patients (74 women and 27 men, aged between 16 and 72 years, mean age 43 years) were evaluated 1–3 months after drug withdrawal therapy had been initiated. The mean headache frequency at baseline was 26.9 ± 4.0 days per month. Fifty-seven (56%) patients were significantly improved (defined as at least 50% reduction in number of headache days) after a period of drug withdrawal therapy. Based on the outcome of the drug withdrawal therapy, the patients were divided into three categories: group I, those who had between 0 and 10 headache days per month ( n = 41), group II, those who had 11–20 days ( n = 37), and group III, those who had 21–30 days ( n = 23). The mean headache frequencies in groups I, II and III were 5.6 ± 2.8 days, 15.7 ± 2.5 days and 28.7 ± 2.4 days, respectively. Treatment with amitriptyline was offered to patients in whom no improvement had been achieved. Ten of those 22 patients (36%) experienced a significant (≥ 50%) reduction of headache days. It is concluded that out-patient drug withdrawal therapy is the treatment of choice in patients with CDH and frequent long-term use of headache symptomatic medication, and that about one quarter of these CDH patients do not respond to drug withdrawal therapy only.