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analgesic rebound headache (transformed headache)

Etiology: 1) daily use of analgesics - consider in any patient taking - opioid, ergotamine, triptan or combination analgesic for > 10 days/month - simple analgesic for > 15 days/month [4] 2) drug tolerance History: - severity of dependence scale may be useful screening tool [3] Clinical manifestations: 1) often occur in the morning or upon awakening 2) generally diffuse 3) prophylactic medications ineffective Management: 1) patient education 2) avoid butalbital & opioids as these agents are associated with increased risk of analgesic rebound headaache [4] 3) prophylactic therapy: a) amitriptyline (Elavil) 10-75 mg PO QHS b) desipramine (Norpramin) 1-50 mg PO QHS c) valproic acid 1] start 125 mg PO QD 2] titrate over 4-5 weeks to therapeutic dose of 250 mg PO TID 4) allow analgesic use to continue for 3-4 weeks while patient is stabilizing on prophylactic therapy 5) taper analgesics over 1 week

General

drug-induced headache; medication overuse headache

References

  1. Kaiser Permanente, Videoconference, 9/9/99, Fresno CA
  2. Zeeberg P et al, Probable medication-overuse headache: The effect of a 2-month drug-free period. Neurology 2006, 66:1894 PMID: 16707727
  3. Grande RB et al The Severity of Dependence Scale detects people with medication overuse: The Akershus study of chronic headache. J Neurol Neurosurg Psychiatry 2009 Jul; 80:784. PMID: 19279030 - Lucas C and Diener H-C. The dependence scale: An easy tool to detect chronic daily headache with mediation overuse? J Neurol Neurosurg Psychiatry 2009 Jul; 80:704. PMID: 19531683
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2015, 2018, 2021.
  5. Johnson JL, Hutchinson MR, Williams DB, Rolan P. Medication-overuse headache and opioid-induced hyperalgesia: A review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment. Cephalalgia. 2013 Jan;33(1):52-64 PMID: 23144180
  6. Carlsen LN, Rouw C, Westergaard ML et al Treatment of Medication Overuse Headache: Effect and Predictors After 1 Year. Headache. 2021;61(7):1112-1122 PMID: 34325483 https://www.medscape.com/viewarticle/956376