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Published on: June 2, 2014
Favorable response to analgesics does not predict a benign etiology of headache
Jennifer V Pope1, Jonathan A Edlow
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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.
Design:
PubMed search of English-language articles between 1980 and 2007 and reference lists of these articles. Two authors independently reviewed articles for study results and quality. Inclusion was based on 100% agreement between authors. We included articles that described secondary HAs as (1) having a favorable response to analgesics and/or (2) having a favorable response to sumatriptan. Of the 548 studies identified by our search strategy, 18 were included in our final analysis.
Results:
Seven of the 18 studies found that 46/103 patients (44%) described a significant or complete resolution of secondary HA from medications such as anti-emetics and nonsteroidal anti-inflammatory drugs (NSAIDs). Eleven of the 18 articles including 25/25 patients (100%) 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.
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