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Favorable Response to Analgesics Does Not Predict a Benign Etiology of Headache
Jennifer Pope, MD; Jonathan Edlow MD.
Posted: July 2008  
Headache   2008;48:944-950

Background:   Distinguishing between primary and secondary headaches (HAs) is essential for the safe and effective management of patients with HA. A favorable response to analgesics may be observed with both classes of HAs and therefore is not a good predictor of who needs further evaluation.

Objective:   To systematically review the data that a favorable response to analgesics including triptans should not be used to exclude a serious secondary cause of HA.

Results:   Seven of 19 studies found that 44% of patients described a significant or complete resolution of secondary HA from medications such as anti-emetics and nonsteroidal anti-inflammatory drugs. One hundred percent of patients described a significant or complete resolution of secondary HA from sumatriptan, a serotonin 5HT agonist.

Conclusions:   A favorable response to analgesics including triptans should not be used to exclude a serious secondary cause of HA.