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Treatment for Chronic Daily Headaches

Treatment for chronic daily headache syndrome

In the beginning, most patients who suffers from chronic daily headaches tend to be resistant to the idea of hospitalization as they believe that headaches are too trivial for such a drastic therapy.  Eventually the degree of their disability may more often than not convinced them or force them to realize the necessity for this. There are controversies regarding the effectiveness of hospitalization and yet there are many studies that have validated and confirmed that this is an effective long-term solution that has proven to work for over 50% of the patients who completed this type of therapy.

Goal of therapy

The goals of the therapy are in fact rather simple. The medications have to be completely withdrawn as soon as possible and the various symptoms of the withdrawal state must be treated as effectively as possible. Of course considerations need to be taken that not all medications can be safely withdrawn abruptly such as butalbital, ergotamine and the various types of narcotics.

Withdrawal state

During the withdrawal state, the initial 48 hours are usually extremely unpleasant for the patient. Very often the patient will experience symptoms of an extremely bad migraine attack such as:

  • a nausea that is really overwhelming
  • vomiting to the point of dehydration
  • severe chemical imbalances

Just purely for this reason, intravenous feeding may frequently need to be given during the first 48 hours. The nausea is often controlled with anti-emetics such as

  • prochlorperazine (Compazine)
  • metoclopramide (Reglan)
  • Intravenous DHE 45
  • methysergide

After the initial 48 hours, the patient will start to recover and a new course of treatment can then be planned, one which will not depend solely on the medications that ultimately made the patient even sicker.

Psychotherapy

Psychotherapy is often beneficial in rehabilitating these patients.  The important factor to note is that these patients did not misuse medications to achieve some sort of euphoric “high” and that they started taking these medications to help provide relief of their headaches or their fear of these headaches. Depression, psychological trauma and other psychological factors can of course influence the patient’s analgesic abuse and should be treated accordingly.

Does Withdrawal Work?

Again there are many controversies as to whether withdrawal is effective or not.  Although not all doctors may agree that this regimen is effective however studies do indicate a good response. Silverstein and Silverstein (1992) have documented that 87% of the patients completing detoxification remain free of analgesic abuse at a 2-year follow-up after their release from hospitalization.