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Withdrawal Therapy Improves Drug-Induced Chronic
Daily Headache
P. Linton Dahlof, et al.
Posted: March 2005  
Cephalalgia, Vol. 20, Number 4

Patients with chronic daily headache (CDH) often overuse headache symptomatic medication and drug withdrawal therapy is generally considered to be the treatment of first choice. The present study is a retrospective analysis of the effect of outpatient drug withdrawal therapy in patients with CDH and frequent long-term use of headache symptomatic medication. One hundred and one adult patients were evaluated. The mean headache frequency at baseline was 26.9 days per month. Fifty-seven patients were significantly improved (defined as at least 50% reduction in number of headache days) after a period of drug withdrawal therapy. Based on the outcome of the drug withdrawal therapy, the patients were divided into three categories: Group I, those who had between 0 and 10 headache days per month; Group II, those who had 11-20 days and Group III, those who had 21-30 days. The mean headache frequency in group I, II and III was 5.6 days, 15.7 days and 28.7 days respectively. Treatment with amitriptyline was offered to patients in whom no improvement had been achieved. Eight of those 22 patients experienced a significant reduction of headache days. It is concluded that outpatient drug withdrawal therapy is the treatment of choice in patients with CDH, and frequent long term use of headache symptomatic medication and that about one quarter of these CDH patients do not respond to drug withdrawal therapy only.