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Low Dose Tizanidine Combined With Long-Acting NSAIDs
for Detoxification From Analgesic Rebound Headache
TR Smith
Posted January 2001
American Headache Society, June 2000

Purpose: This retrospective study was aimed at quantifying whether low, nocturnal doses of tizanidine (Zanaflex), an alpha-2 adrenergic agonist, as an adjunct to NSAIDs, would provide detoxification from analgesic rebound headache.

Results: Of the 55 charts assessed in this retrospective analysis, 5 patients were lost to follow-up or discontinued their medications. Of those patients who continued the program for at least 12 weeks, 38 had trivial or no analgesic use at the 12-week endpoint. This represents a 68% responder rate for the tizanidine/NSAID detoxification program. Three patients had discontinued the program due to side effects.

Conclusion: Given the limitations of a retrospective chart review, this study suggests that the combination of low dose tizanidine with a daily long-acting NSAID can be useful in the treatment of analgesic rebound headache. This treatment is a helpful bridge through the period of analgesic withdrawal. In this series of patients, the treatments were well tolerated and exhibited a high degree of efficacy.