Objective: To determine the frequency of potential analgesic rebound headache in a series of patients presenting to a university-based headache clinic and to identify variables influencing the presence or absence of analgesic overuse.
Background: Overuse of analgesic medications is considered by may to be integral to the development and maintenance of chronic headache in a high proportion of those so affected.
Methods: Eighty-three consecutive patients with chronic pervasive headaches (>15 days/month for >2 months) were evaluated at the University of South Alabama Headache Center. Age, gender, primary headache sybtype, duration of chronic headache and pattern/frequency of symptomatic medication use were assessed. Rebound headache was considered potentially to be present if the patient reported use of any given symptomatic medication >3 days/week on a chronic basis.
Results: Eighty-nine percent of the 83 patients were female. Mean age was 42 (range 14-77). Sixty-three (76%) patients had chronic daily headache, and 20 (24%) had frequent episodic migraine (FEM). Analgesic rebound headache was potentially present in 37% of patients overall (41% of patients with daily headache vs. 25% with FEM) and was most common (60%) in the subgroup with chronic daily heacache (CDH) type II (new daily persistent headache with migrainous features). Potential rebound was more common in patients > age 40 (58% vs. 42%) and in patients with CDH of > 1 years duration (60% vs. 40%).
Conclusion: Although overuse of analgesic medication is common in this population and may influence the incidence and prognosis of pervasive headache, a minority of patients reports overuse. Overuse is apparently more common in older patients with CDH of > 1 years duration