RESEARCH - Does chronic daily headache arise de novo in association with regular use of analgesics?

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Does Chronic Daily Headache Arise De Novo in Association With Regular Use of

Analgesics?

Authors: Bahra A.1; Walsh M.2; Menon S.3; Goadsby P.J.1

Source: Headache: The Journal of Head and Face Pain, Volume 43, Number 3,

March 2003, pp. 179-190(12)

Abstract:

Background.-The prevalence of chronic daily headache in association with

regular use of analgesics is about 2%. Whether regular use of analgesics has

a causal or consequential relationship to daily headache has not been

established. A causal relationship has been suggested consequent to the

observation of improvement or resolution of headache following analgesic

withdrawal in patients attending headache clinics, but this observation has

not been validated by controlled trials. Purpose.-The aim of our

investigation was to determine whether regular use of analgesics is

associated with the development of chronic daily headache de novo and to

characterize the clinical phenotype of those headaches by carefully studying

chronic daily headache in patients with regular use of analgesics for a

nonheadache indication. Methods.-Patients attending a

rheumatology-monitoring clinic of second-line agents were interviewed by a

training neurologist with regard to their analgesic and headache history.

Headache classification was according to the criteria of the International

Headache Society. Daily headache characteristics were surveyed via a

standardized questionnaire, and headache features were further explored by a

trained medical interviewer. Results.-Of 110 patients presenting to a

rheumatology-monitoring clinic, 73% had a diagnosis of rheumatoid arthritis,

23% had seronegative arthritis, and 4% comprised a miscellaneous group. One

hundred three were using one or more analgesics regularly for their

arthritis. Of this group, 8 (7.6%) reported a history of chronic daily

headache, each of whom reported a history of migraine. The onset of migraine

occurred before the onset of chronic daily headache in 7 patients and at

about the same time as the chronic daily headache in 1 patient. In those

with onset of migraine prior to chronic daily headache, the mean interval

before the onset of headache was 30 years (range, 10 to 50 years). Regular

use of analgesics preceded the onset of daily headache in 5 patients by a

mean of 5.4 years (range, 2 to 10 years). In 1 patient, analgesic use and

the development of daily headache occurred at about the same time. In 1

patient, the onset of daily headache preceded regular use of analgesics by

almost 30 years. Five of those with regular use of analgesics had been

taking an opiate-based preparation in combination with a nonsteroidal

anti-inflammatory agent in 4. Two had been on a combination of acetaminophen

(paracetamol) and a nonsteroidal anti-inflammatory drug. The minimum number

of tablets per week was 7, and the mean was 48 (range, 7 to 87). Of those

patients who did not have daily headache, 41% had a history of migraine and

27% reported a history of tension-type headache. Conclusion.-These findings

suggest that individuals with primary headache, specifically migraine, are

predisposed to developing chronic daily headache in association with regular

use of analgesics.

http://www.ingentaconnect.com/content/bsc/hed/2003/00000043/00000003/art00003

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