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In-Patient Treatment of Chronic Daily Headache Using Dihydroergotamine: a Long-term Follow-up Study

Published online by Cambridge University Press:  18 September 2015

Tamara Pringsheim
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
David Howse*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
*
Richardson House, 102 Stuart Street, Kingston, Ontario, Canada K7L 2V6
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Abstract:

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Background:

The treatment of chronic daily headache (CDH) due to medication overuse remains a common and difficult problem. For selected patients refractory to outpatient management we have used a treatment protocol using dihydroergotamine (DHE) as introduced by Raskin, during a brief (typically 48 hours) in-patient stay. While many studies have documented the short-term efficacy of the DHE protocol, there are limited data on its long-term effects. The purpose of this study was to evaluate the efficacy of the protocol on headache frequency and severity, analgesic use, absences from work, and quality of life, at three months post treatment and the present time.

Methods:

A retrospective chart review of all patients admitted for the DHE protocol from 1991 to 1996 revealed 174 cases. Of these, 132 patients were interviewed by phone.

Results:

The DHE protocol was shown to decrease headache frequency, severity, headache medication use, and absences from work both at three months and the time of interview.

Conclusion:

This study has the largest patient base and the longest follow-up period for the use of DHE for CDH. The results confirm that the DHE protocol is helpful in breaking the cycle of CDH, although the long-term outcomes of this study are more conservative than other studies have reported.

Type
Original Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

References

REFERENCES

1.Newman, LC, Lipton, RB, Soloman, S, Stewart, WF. Daily headaches in a population sample: results from the American Migraine Study. Headache 1994; 34: 295.Google Scholar
2.Mathew, NT. Chronic refractory headache. Neurology 1993; 43 (Suppl 3): S26-S33.Google Scholar
3.Silberstein, SD, Lipton, RB, Sliwinski, M. Classification of daily and near daily headaches: field trial of revised HIS criteria. Neurology 1996; 47(4): 871875.CrossRefGoogle Scholar
4.Raskin, NH. Acute and prophylactic treatment of migraine: practical approaches and pharmacologic rationale. Neurology 1993; 43 (Suppl 3); S39-S42.Google ScholarPubMed
5.Raskin, NH. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology 1986; 36: 995997.CrossRefGoogle ScholarPubMed
6.Silberstein, SD. The pharmacology of ergotamine and dihydroergotamine. Headache 1997; 37 (Suppl 1): S15-S25.Google ScholarPubMed
7.Goadsby, PJ, Edvinsson, L. The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats. Ann Neurol 1993; 33: 4856.CrossRefGoogle Scholar
8.Silberstein, SD, Schulman, EA, McFadden-Hopkins, M. Repetitive intravenous DHE in the treatment of refractory headache. Headache 1990; 30: 334339.CrossRefGoogle ScholarPubMed
9.Silberstein, SD, Silberstein, JR. Chronic daily headache: long-term prognosis following in-patient treatment with repetitive IV DHE. Headache 1992;32:439445.CrossRefGoogle Scholar