Posted by Bob Johnson (188.8.131.52) on December 09, 1999 at 07:52:33:
In Reply to: more about rebound headaches, seems like:........ posted by gary on December 08, 1999 at 18:13:20:
Posted by Bob Johnson (184.108.40.206) on August 05, 1999 at 13:35:22:
An important report from the Vanderbilt (Univ) Headache Clinic says: migraine/cluster-like headaches may be, in reality, rebound headaches, that is attacks which arise from the overuse of a wide variety of analgesics. Then, the very medications used to treat the mig/cluster-like attack, keeps the whole process going, creating new attacks.
Since I can't summarize this complex, 12-page article, there are a few clues which you can use to examine your history of headache to see if this material applies to you. If the answer is yes, I'd suggest getting a copy of this article and share it with your doc, for a sophisticated diagnosis is needed to make sure that the treatment for your cluster is not, in fact, keeping them going.
Clues are: 1. History of injury, surgery, illness, trauma, or an incident which lead to the almost daily use of aspirin, acetaminophen, NSAID, an opiate, an ergotamine (except DHE), sumatriptan (and others in this family), or any combination.
2. The continued, almost daily, use of these products because the headache won't go away. THIS PATTERN (of daily use) MAY HAVE STARTED WITH A TENSION-LIKE HEADACHE and only later (ranging from weeks to years) did a mig/cluster-like headache pattern develop.
3. Presently, "narcotics, serotonin agonists, and other measures which are effective in terminating isolated [major attacks] will only dull but seldom terminate these [major attacks]" which now seem continuous.
"The typical patients with RH describe daily or near daily tension-type headache with superimposed mig/cluster-like attacks which are more frequent and more prolonged than any isolated (attack) which had been experienced in the years prior.... They are taking daily or almost daily medications for pain relief which only dull and rarely terminate their headache. They report constant pain during every waking hour. It should be stressed that this is the typical picture and certainly does not include every patient...."
Vanderbilt reports that this cycle: tension headache + daily analgesic use + later development of mig/cluster-like attacks, is often overlooked by patient and doctor. The focus on the cluster intensity pain prevents taking a good history which might otherwise have revealed this development.
You can get a copy from your local library (via Interlibrary loan) or from the medical library in larger hospitals.
"Rebound Headaches--A Review", Au. John S. Warner, M.D., in HEADACHE QUARTERLY, 10:3 (1999).
As you can see, this problem is difficult to diagnose for there are many "perhaps, could be, sometimes" qualifiers. This is why you need to work with a doc who is sensitive to the issue and has some experience sorting through the basic cluster pattern from medication induced attacks which appear as a cluster attack. (In the article, the author makes a clear distinction between a CH and the medication induced attack which he refers to as "cluster-like".
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