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.
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