Clinical Manifestations of Excessive Use of Analgesic Medication

Physicians experienced in the treatment of migraine and other forms of headache are nowadays well aware that the daily intake of antipyretic or anti-inflammatory analgesics or combinations with ergotamine, sedatives, or hypnotics may result in chronic daily headache. Conversely, if a patient complains of daily headache and takes “pain killers” daily, this headache is most likely to be caused and sustained by the medication and will vanish with abstinence. Chronic headache was originally attributed to the excessive use of ergotamine preparations (Lippman 1955; Horton and Peters 1963; Lucas and Falkowski 1973; Rowsell et al. 1973; Wainscott et al. 1974; Andersson 1975; Dige-Petersen et al. 1977; Hokkanen et al. 1978; Ala-Hurula et al. 1982; Pradalier et al. 1984) and was therefore named “ergotamine headache.” A number of subsequent reports from different countries in Western Europe and the United States, however, indicated that analgesics may induce chronic headache as well (Worz et al. 1975; Medina and Diamond 1977; Tfelt-Hansen and Krabbe 1981; Kudrow 1982; Isler 1982; Worz 1983; Dichgans et al. 1984; Henry et al. 1985; Rapaport et al. 1985). We, therefore, propose to add to the original terms “ergotamine headache” and “analgesic headache” a new entity and to include both under the term “drug-induced headache.”