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We Need Better Preventative Medication
Lawrence Robbins, MD
Posted May 2002
Headache 2001; 41:611-612

Our previous retrospective study of 540 patients with chronic daily headache indicated that only 46% achieved long-term (more than 9 months) relief with preventative medications. Each patient in the study had been on at least three preventative medications; lack of efficacy was the primary reason for discontinuation, but side effects resulted in 20% of patients discontinuing medication. The percentages of patients who had relief and continued long-term on preventative medication included: sodium valproate, 35%; selective serotonin reuptake inhibitors, 35%; tricyclic antidepressants, 31% and -blockers, 22%.

Most controlled studies do not extend beyond 6 months; dropout rates are high between months 6 and 12. While they may be difficult and cost-prohibitive, we need longer preventative studies.

We tell patients not to overuse (or even use) analgesics or abortives, then we present them with daily preventatives that often are not effective and have intolerable side effects. Patients feel guilty and frustrated when five or six preventative medications are ineffective, and physicians share in their frustration.

We must urge the pharmaceutical companies to develop novel preventative medications for chronic daily headache. In addition, it will help patients if we present a realistic picture as to the possibilities for success with preventatives.

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