Analgesic rebound headache: experience in a community hospital

In the past, chronic daily headaches have been attributed to many possible causes, including "tension," excessive contraction of pericranial muscles, and depression. A careful history reveals that many patients start out with fairly typical intermittent migraine attacks that evolve over the years into a pattern of daily or almost daily head pain. Overuse of analgesics is usually a part of this clinical picture, which has been termed "analgesic rebound headache." Fifty-three of the first 100 patients admitted to a community hospital's inpatient headache treatment program had chronic daily headaches and were overusing analgesics or other headache relief medications. We report our retrospective review of these patients and describe treatment of this difficult and sometimes unrecognized syndrome, primarily with intravenous dihydroergotamine (DHE). Results at hospital discharge and at follow-up several months later showed significant reduction of pain.