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Posted by Ted ( on December 04, 1999 at 01:41:08:

Carl, your overuse of ergotamine concerned me and I came across the following information for you from an article that I also am providing a link for:Drug Habituation and Detoxification
Because drug habituation commonly accompanies many chronic headache syndromes, it is often the first issue that must be considered in patient management. Medications that are known to cause habituation and rebound headaches include opioids, barbiturates (Fiorinal, Fioricet, Esgic, Axotal, Phrenelin), ergotamine tartrate compounds (Cafergot, Wigraine), benzodiazepines, and caffeine-containing analgesic preparations (Anacin, Excedrin, Vanquish, and others). There is no evidence that simple analgesics, such as aspirin, acetaminophen, or NSAIDs cause rebound headaches with daily use.

Detoxification from habituating drugs is the initial step in the treatment of patients who are taking excessive pain medications (i.e., using daily or almost daily habituating pain medication, or taking ergotamine more than twice weekly). Prophylactic medication is ineffective in patients suffering from rebound or withdrawal headaches. Frequently, patients say that they "would stop taking pain medication if only the preventative medication prevented the headaches." Patients must be instructed that the "pain medication" itself is part of the cause of the headaches, and that headache therapy is futile until the rebound-habituation cycle is resolved.

Management of the habituated patient can be difficult, and the medical literature offers little insight into proper techniques of detoxification. Patients who are habituated to opioids can benefit from clonidine (Catapres) to prevent physical signs and symptoms of withdrawal. Glucocorticoids and phenothiazines may be prescribed for outpatient detoxification from butalbital, ergotamine, or low doses of opioids. Generally, a 6 to 14 day tapered course of glucocorticoid is given, with chlorpromazine (Thorazine) suppositories prescribed for severe withdrawal headaches associated with vomiting. For patients with concomitant medical problems, a history of seizures, or unsuccessful outpatient detoxification, inpatient detoxification is often required.

The management of chronic headache disorders requires close follow up and frequent physician visits until therapy is successful with a minimum of adverse effects. Although this approach takes commitment on the part of both the practitioner and the patient, good results should be expected in the vast majority of cases.


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