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Headache Induced by Chronic Substance
Use: Analysis of Medication Overused and
Minimum Dose Required to Induce Headache
Giuliano Relja, MD; Antonio Granato, MD, et al.
Posted: March 2004  
Headache 2004;44:148-153

Objective:   To consider whether the International Headache Society criteria for headache induced by substance use and the proposed revisions for the classification of daily and near-daily headache with medication abuse permit classification of patients commonly seen in a headache center.

Results:   Eighty-one patients (71%) had an initial headache of migraine without aura, 13 patients (11.4%) had migraine without aura and coexistent tension-type headache, 11 (9.7%) patients had migraine with and without aura, and 9 patients (7.9%) had episodic tension-type headache. Medications overused by patients included analgesics combined with barbiturates or other nonnarcotic substances in 39.5%, simple analgesics in 38.6%, triptans in 11.4%, and ergotamine in 10.5%. Using the International Headache Society diagnostic criteria, we were able to classify only 28.1% of our patients; the proposed revised criteria for daily and near-daily headaches with medication abuse permitted the classification of 46.4% of patients.

Conclusion:   The minimum dose of medication required to induce chronic headache should be revised because a high proportion of patients are not classifiable using either the International Headache Society diagnostic criteria or the revised criteria recently proposed. A more comprehensive definition for the required minimum dose might be used. Triptan abuse can cause chronic headache and should be included in the International Headache Society classification.