Managing Chronic Headaches

A common type of daily headache is medication overuse headache and one group examined whether this was more likely with the use of certain medicines. Almost 100 Spanish neurologists were asked to categorise different drug groups and their link to medication overuse headache (MOH). They concluded that ergots were most likely to be abused and cause MOH, followed by analgesics; triptans were less likely to cause problems.

A small study looked at the factors that would lead to a successful long-term withdrawal from medicines in MOH. Those who had withdrawn from drugs were followed up 3-6 years later and it was found that those that smoked heavily, had a higher intake of medication, a family history of headache were more likely to have relapsed. Those who had been overusing non-steroidal anti-inflammatory drugs [e.g. aspirin, ibuprofen] were less likely to have relapsed.

Investigations on ways to help MOH sufferers overcome their problems suggested for those with migraine and MOH who have low medical needs, sound advice alone may be sufficiently successful in helping sufferers withdraw from their medicines. In those with more severe pre-existing migraine there is more chance of relapse.

Another study found injecting the local anaesthetic lidocaine into pericranial trigger points in chronic migraine and MOH sufferers twice weekly for three weeks, in addition to preventative drugs of drug withdrawal reduced pain, even after the first injection. In addition, the antidepressant duloxetine, given once a day for two months, reduced the number of headaches in 60% of chronic tension headache sufferers. However, this was a small, open-label trial and the results need further investigation. Ziprasidone, an antipsychotic treatment, reduced chronic daily headache and chronic migraine frequency when added to other treatment, suggesting the ability to block the brain transmitter dopamine could play a part in treating chronic headaches.

Prophylaxis of migraine often involves flunarizine or topiramate as first-choice drugs. Both treatments reduced the mean number of migraine attacks in sufferers of chronic migraine after four months use, although there was a greater reduction with topiramate (61.9%) than flunarizine (41.1%). Topiramate could be considered a first-line treatment for chronic migraine, say the authors.

Meanwhile, the debate over the possible benefits of botox in headache disorders continues. While some studies suggest a lack of efficacy in migraine and tension headache treatment, others suggest the opposite. The potential for botox (botulinum toxin type A) to prevent chronic daily headache (CDH) was examined in 1350 CDH sufferers. After 12 months of treatment CDH sufferers reported being free from headache on 23 days per month, suggesting botox could be of value in these headache sufferers, especially those that do not respond to other prophylactic treatments.