What Kind of Drugs Are Taken by Patients with Primary Headaches?

Abstract

The daily or almost daily intake of monoanalgesics, analgesic and ergotamine combinations, or opioids may, in patients with primary headaches, cause a continuous headache, which is defined as “analgesic-induced rebound headache” (Andersson 1975; Hokkanen et al. 1978; Tfelt-Hausen and Krabbe 1981). This drug-induced headache occurs predominantly in patients suffering from migraine (Andersson 1975; Mathew et al. 1982; Wilkinson 1983) tension headache (Rapoport 1984; Ziegler 1985), or combination headache (which is a combination of migraine and tension headache) (Mathew 1981; Saper 1982; Pfaffenrath et al. 1986) and manifests itself, mainly at alternating sides and as a daily, partly throbbing, partly dull headache (Kudrow 1982; Rapoport 1984) with accompanying minor vegetative and visual symptoms. The analgesic-induced headache resembles the basic primary headache, and its differentiation from the latter causes major problems, both for the affected patient and the physician. It is maintained by a sometimes almost careless use of analgesics, by the patients fear of the next attack and finally by his addiction to the barbiturates and opioids contained in the compound preparations (Wörz 1983; Dichgans et al. 1984; Rapoport 1984). After a period of habituation due to the psychotropic effects of barbiturates and opioids, a psychophysical dependence results, which might be enhanced in individual cases by an abuse of tranquilizers.