Get access

Favorable Response to Analgesics Does Not Predict a Benign Etiology of Headache

Authors


  • Conflict of Interest: None

J.V. Pope, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

Abstract

Background.— Distinguishing between primary and secondary headaches (HAs) is essential for the safe and effective management of patients with HA. A favorable response to analgesics may be observed with both classes of HAs and therefore is not a good predictor of who needs further evaluation.

Objective.— To systematically review the data that a favorable response to analgesics including triptans should not be used to exclude a serious secondary cause of HA.

Design.— PubMed search of English-language articles between 1980 and 2007 and reference lists of these articles. Two authors independently reviewed articles for study results and quality. Inclusion was based on 100% agreement between authors. We included articles that described secondary HAs as (1) having a favorable response to analgesics and/or (2) having a favorable response to sumatriptan. Of the 548 studies identified by our search strategy, 18 were included in our final analysis.

Results.— Seven of the 18 studies found that 46/103 patients (44%) described a significant or complete resolution of secondary HA from medications such as anti-emetics and nonsteroidal anti-inflammatory drugs (NSAIDs). Eleven of the 18 articles including 25/25 patients (100%) described a significant or complete resolution of secondary HA from sumatriptan, a serotonin 5HT agonist.

Conclusions.— A favorable response to analgesics including triptans should not be used to exclude a serious secondary cause of HA.

Ancillary