It was this glaring difference in clinical presentation that prompted me to prescribe indomethacin preventively to my patient with hemicrania continua, as opposed to considering him as having medication-overuse headache and discontinuing his use PD0325901 ic50 of aspirin, which he took

abortively on a daily basis, several times per day. Medication overuse represents the intake of analgesic and/or vasoconstrictor medications at a frequency that is detrimental rather than beneficial to the headache condition. Their intake may provide some temporary headache relief short term, but in the long run promotes the occurrence of headaches. The mechanisms involved include neglect of underlying headache pathophysiology and creation of a vascular rebound cycle, respectively. The latter occurs with the use of vasoconstrictor medications at intervals EGFR activity that allow them to accumulate in the system, causing rebound vasodilation and headache whenever their effects wear off. Medication overuse is a common accompaniment of chronic daily headache, simply because of the frequency of headache occurrence. The vasoconstrictor agent most commonly involved in medication-overuse

headache is caffeine, either in caffeinated beverages or in combination products, such as the butalbital combinations. It is often not realized that caffeine’s plasma elimination is quite variable, and its half-life can be as long as 10 hours.[14] It takes up to 5 times the half-life for a medication to be eliminated from the system, which for caffeine means potentially up to 50 hours or a little over 2 days. In order to avoid accumulation in the system and, hence, rebound or medication-overuse headache, caffeine should not be taken for headache more often than 2 or 3 times per week. This precludes the

use of caffeine-containing medications, such as the butalbital combinations, for the treatment of chronic migraine with its occurrence of headache on a daily or almost daily selleck chemicals llc basis. Interestingly, a study of 116 episodic migraineurs with regular caffeine intake found that complete cessation of caffeine intake produced a greater than 50% reduction in headache frequency, compared with 9.9% who reduced intake by 50% or more and 0% in those who made no change in their caffeine intake (P < .001).[15] In the studies reviewed above conducted by Robbins,[7] Robbins and Maides,[6] and Piekos and Spierings,[1] and as mentioned, the patients were not deliberately placed on daily triptan but rather discovered, on their own, that the triptan is highly effective for the treatment of their daily headaches.