1Associate Professor of Neurology, Temple University School of Medicine. Director, The Comprehensive Headache Center at the Germantown Hospital and Medical Center
Chronic Daily Headache: Long-Term Prognosis Following Inpatient Treatment With Repetitive IV DHE
Article first published online: 19 MAY 2005
Headache: The Journal of Head and Face Pain
Volume 32, Issue 9, pages 439–445, October 1992
How to Cite
Silberstein, S. D. and Silberstein, J. R. (1992), Chronic Daily Headache: Long-Term Prognosis Following Inpatient Treatment With Repetitive IV DHE. Headache: The Journal of Head and Face Pain, 32: 439–445. doi: 10.1111/j.1526-4610.1992.hed3209439.x
- Issue published online: 19 MAY 2005
- Article first published online: 19 MAY 2005
- Accepted for publication July 15, 1992
- Chronic daily headache;
- tension headache
We retrospectively studied the long-term (2-year) outcome of 50 consecutive patients admitted to our inpatient headache program because of chronic daily headache (CDH) associated with the overuse of analgesics, ergotamine, or both. They had been detoxified, given repetitive intravenous dihydroergotamine (IVDHE) and prophylactic medications as part of the program, and had become headache-free on this regimen. At the time of admission, 37 of the 50 patients had transformed migraine (TM), 12 had new daily persistent headache (NDPH), and 1 had chronic tension-type headache; 29 of the patients with TM, 7 of those with NDPH, and the single patient with chronic tension-type headache had coexistent migraine. Substances abused, alone or in combination, included: caffeine in 39 patients (av. 441 mg/d), acetaminophen in 32 (av. 2187 mg/d), aspirin in 24 (av. 1807 mg/d), ibuprofen in 9 (av. 1156 mg/d), narcotics in 7 (av. 10.1 mg morphine equivalents/d) and ergotamine in 11 (av. 2.3 mg/d). Twenty patients were using preventive medication at the time of admission. Follow-up evaluations were performed at 3, 6, 12, and 24 months after discharge. Forty-three patients were analyzed at 3 months. Of these, 44% had an excellent or good result and 28% a fair result; 3 were overusing analgesics. At 24 months, 39 patients were analyzed: 59% had a good or excellent result and 28% a fair result; 5 were overusing analgesics, 4 of whom were doing poorly.
We conclude that most patients (87%) detoxified from analgesic/ergotamine overuse as part of an inpatient treatment program using repetitive IV DHE continue to do well over the long term, as demonstrated by the findings obtained during 2 years of follow-up.