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Management of Chronic Daily Headache Utilizing a Uniform Treatment Pathway

Authors

  • John F. Rothrock MD

    Corresponding author
    1. From Ochsner Clinic, New Orleans, La.
      Address all correspondence to Dr. John F. Rothrock, University of South Alabama Medical Center, Department of Neurology, 2451 Fillingim Street, Mobile, AL 36617.
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Address all correspondence to Dr. John F. Rothrock, University of South Alabama Medical Center, Department of Neurology, 2451 Fillingim Street, Mobile, AL 36617.

Abstract

Objective.—To determine if the use of a uniform treatment pathway might be effective in treating patients with primary chronic daily headache.

Methods.—Thirty-three consecutive patients with primary chronic daily headache were managed according to a treatment pathway which involved sequential administration of divalproex sodium, amitriptyline, amitriptyline plus phenelzine, or methadone.

Results.—Twenty-two patients (67%) reported a 50% or greater reduction in headache days per month following initiation of treatment. Most positive treatment responses (17 [77%] of 22) were attributed to divalproex sodium.

Conclusion.—Implementation of a uniform treatment pathway may result in significant clinical improvement in a sizable proportion of patients with chronic daily headache.

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