Treatment of secondary headaches is primarily to eliminate the disease that caused them. In the process of treating the underlying disease, permanent or recurrent headaches can be stopped by the above-described drugs used to prevent headaches or arrest their seizures.
Treatment of headaches caused by regular intake of drugs should begin with identifying the fact of their regular intake and their cancellation.
Any symptomatic or prophylactic treatment is usually ineffective as long as patients are taking the drug in high doses.
For this reason, new drugs are not prescribed until they establish the fact of drug abuse as the cause of headaches (about the headache) and do not cancel these “causal” drugs.
Treatment of headache, probably due to excessive medication:
1. Stop taking non-opioid analgesics and triptans.
2. Reduce the dose of opioids, combined butalbital and ergotamines to 0.5-1 tablets per week
3. To prescribe neibuprofenovoy NSAIDs or tramadol in low doses, which are taken 2 times a day in combination with a single dose of the usual dose of the drug for severe pain, during the first month after the withdrawal of analgesics or the entire period of reducing the dose of drugs
4. Re-evaluate the nature of headaches a month after the cancellation of analgesics and triptans, or the maximum reduction in the dose of drugs
5. Frequently occurring headaches should be treated with traditional prophylactic agents.
6. Limit the use of medicines used as symptomatic treatment to 3 days a week and recommend their use only for rare, severe attacks of headaches.
7. To control the overuse of symptomatic drugs, an analysis of data from headache diaries is necessary.
You can quite successfully cancel the drug in an outpatient setting. Essentially, detoxification is not strictly necessary. Thus, during a special study, 120 patients suffering from aboutuse headache were randomly assigned to three groups.
The first group was asked to stop using drugs that cause abuse headaches. Patients of the second group proposed an outpatient detoxification program, which includes, along with the abolition of the useus drugs, the use of prednisone and prophylactic drugs.
The third group consisted of patients who used the detoxification program in the hospital, including prednisone and prophylactic drugs in combination with infusion therapy and antiemetic drugs. When evaluating the results of an experiment conducted after 2 months, no significant differences were found between the three groups of subjects.
Therefore, any treatment of patients suffering from a headache of drugs, you must start with the abolition of abuzusnyh drugs.
To compare the nature of headaches before and one month after the complete abolition of medicines, you should re-analyze the data of the diaries in order to trace the changes in the nature of the headaches. Simply eliminating drugs is effective in more than half of the patients suffering from aboutuse headaches.
Of the 216 such patients whose treatment consisted in drug withdrawal within 2 months, the frequency of painful pain episodes decreased in 45% and did not change in 48% of respondents. The following is noteworthy: in spite of the frequent fears of patients that drug withdrawal will provoke an increase in headaches, in reality it was noted only in 7%. These data demonstrate the benefits of the method of drug withdrawal.
Later, the study revealed: despite the conviction of patients that increasing the dose of drugs relieves headaches, their excessive use is ultimately ineffective. Few patients have doubts about the advisability of canceling over-used drugs.
Keeping diaries after a period of withdrawal of abuzusnyh drugs will help determine whether to apply symptomatic agents or apply prophylactic treatment. Patients who subsequently have frequent headaches should be prescribed prophylactic treatment.
Since drug abuse not only leads to an increase in headache attacks, but also causes resistance to prophylactic treatment, its effectiveness increases significantly after the abusive drugs are discontinued. In the course of a special study, patients treated for abuses headaches were analyzed, 47% of whom received prophylactic treatment.
A significant decrease in the frequency of headaches was also recorded in patients who had not previously noted efficacy from prophylactic treatment (a reduction in frequency in 49%) and in those to whom it was never applied (a decrease in frequency in 56%). Therefore, after the withdrawal of the abuzus drugs, patients who continue to experience frequent headaches are advised to prescribe new prophylactic agents as well as resume medications that were previously ineffective.