Main description:

M. WILKINSON Patients with frequent or daily headaches pose a very difficult problem for the physician who has to treat them, particularly as many patients think that there should be a medicine or medicines which give them instant relief. In the search for the compound which would meet this very natural desire, many drugs have been manufactured and the temptation for the physician is either to increase the dose of a drug which seems to be, at any rate, partially effective, or to add one or more drugs to those which the patient is already taking. Although there have been some references to the dangers of overdosage of drugs for migraine in the past, it was not until relatively recently that it was recognized that drugs given for the relief of headache, if taken injudiciously, may themselves cause headache. The first drugs to be implicated in this way were ergotamine and phenazone. In the case of ergotamine tartrate, the dangers of ergotism were well known as this was a disorder which had been known and written about for many years. In the treatment of headache, fully blown ergotism is rare and in recent years has usually been due to self-medication in doses much greater than those prescribed although there are a few recorded cases where toxic amounts have been given.

Contents:

Clinical Aspects of Drug-Induced Headache.- Daily Chronic Headache - Tension Headaches, Migraine, and Combined Headaches: The Transformation Concept.- Clinical Manifestations of Excessive Use of Analgesic Medication.- Ergotism - The Clinical Picture.- Clinical and Epidemiological Observations on Drug Abuse in Headache Patients.- Drug-Induced Headache - Does a Critical Dosage Exist?.- What Kind of Drugs Are Taken by Patients with Primary Headaches?.- Psychological, Behavioral, and Social Aspects of Drug-Induced Headache.- The Role of Behavioral and Social Factors in the Development of Drug-Induced Headache.- Dependence on Analgesic Medication in Chronic Headache Sufferers: Psychological Analysis.- Psychiatric Aspects of Drug Addiction of the Barbiturate-Alcohol Type.- Pharmacological Aspects of Drug-Induced Headache.- Headache Drugs Provoking Chronic Headache: Historical Aspects and Common Misunderstandings.- Possible Pharmacological Mechanisms of Chronic Abuse of Analgesics and Other Antimigraine Drugs.- Clinical Pharmacology of Ergotamine An Overview.- Ergotamine Tartrate Dependency: Possible Mechanisms.- Platelet Reactivity in Ergotamine Headache Compared to Migraine and Muscle Contraction Headache.- Treatment of Drug-Induced Headache.- Short- and Long-Term Effects of Withdrawal Therapy in Drug-Induced Headache.- Therapeutic Approach to Drug Abuse in Headache Patients.- Management of Ergotamine Withdrawal.- Possible Mechanisms and Treatment of Analgesic-Induced Chronic Headache.- Characteristics and Treatment of Analgesic Rebound Headache.- Conclusions.