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Treatment and Outcome of Chronic Daily Headache
Posted July 2000

Background and Objective: Chronic daily headache, whether or not associated with analgesic overuse, is a therapeutic challenge. To date no consensus exists regarding the best medical approach. Additionally, outcome in the long run is not well known. In this study we examine the long-term clinical evolution of patients treated for chronic daily headache with a standardized protocol.

Design and Methods: We retrospectively studied patients selected from a university headache center. They had a diagnosis of chronic daily headache (more than 15 days a month and 4 hours a day). Patients were admitted because they judged it necessary, and stayed for 2-4 days for the initiation of treatment. They were then followed in the clinic. Data were taken from the charts and completed if necessary by telephone interview. Only patients with adequate data were included. Treatment consisted of Metoclopramide/Dihydroergotamine IV scheduled round the clock (modified Raskin protocol) for 2-3 days and Doxepine or Amitriptyline as prophylaxis. Secondary measures included duration of the chronic daily headache, presence - and recurrence - of analgesic abuse, percentage of non-responders, of relapses, and side effects.

Results: Twenty-six patients were included (21F/5M). Twenty-four used excessive analgesics. Two were given Amitriptyline, the others Doxepine, for .5 to 24 (av.6) months) Average monthly headache index was: 92, 62, 58 & 54 respectively at entry, 1, 6 & 12 months. Eleven patients still took analgesics at 12 months.

Conclusion: This study suggests that treatment - initiated inpatient - of severe chronic daily headache with modified Raskin protocol and tricyclics may improve patients' disability for a few months. However, further improvement beyond the initial phase seems marginal. This type of treatment should be considered for these patients but should be optimized for further long-term benefit.