Drug-induced headache

from Wikipedia, the free encyclopedia
Classification according to ICD-10
G44.4 Drug-induced headache, not elsewhere classified
ICD-10 online (WHO version 2019)

Drug-induced headaches are all types of headache that result solely from taking or withdrawing from medication , often pain relievers. They represent a subgroup of substance-induced headaches. A distinction must be made between headache caused by excessive use of painkillers or their withdrawal and headache as a direct side effect of other drugs.

IHS classification

8. Headache attributed to a substance or its withdrawal
8.1. Headache induced by acute substance use or acute substance exposure
8.2. Headache from drug overuse
through ergotamines, triptans, analgesics, opioids, mixed painkillers, other drugs
8.3. Headache as a side effect attributed to long-term medication
8.4. Headache attributed to substance withdrawal

(The current classification of the International Headache Society was published in 2004.)

Epidemiology

The frequency peak is in middle age. 5 to 8% of all headache patients develop a drug addiction. Women are clearly overrepresented with a ratio of 10: 1.

etiology

First of all, a primary headache disorder (mostly migraine or tension headache ) is required as a basis. This provides the original reason for taking pain medication.

In theory, if you take analgesics more often , the nervous system increases its sensitivity to pain, so the pain threshold (subliminal stimuli are not perceived as pain) decreases. Normally non-painful stimuli are perceived as pain, which leads to increased use of the painkillers. From a behavioral point of view, there is thus a learning process.

In principle, all analgesics can lead to a drug-related headache. However, those affected often take mixed preparations that contain psychotropic substances ( caffeine , codeine ). There is a close relationship here with addictions.

A special form is the headache as a direct side effect of other substances. Among the drugs most play nitrates , calcium channel blockers , amiodarone , lithium and steroid hormones an important role. In addition, many intoxicants ( alcohol , cannabis , cocaine ) can lead to headaches. Other substances include sodium glutamate , carbon monoxide and phosphodiesterase inhibitors .

Symptoms

The headache occurs mostly daily, but at least 15 days per month. The localization can be unilateral or bilateral, the intensity is moderate to high. The pain is described as dull or oppressive, but also stabbing or pulsating. They are not infrequently accompanied by nausea, need for rest, sensitivity to light or noise. This headache is therefore a mixture of a migraine-like and a chronic tension-type headache.

Taking the medication reduces the pain, but at the end of the period of action it returns unabated ( rebound ).

therapy

The only effective treatment is drug withdrawal. This requires a high level of patient motivation. Attempts should be made to build this up by providing detailed information about the cause of the symptoms and possible long-term effects (especially kidney and stomach damage). Furthermore, information must be provided about the expected course of withdrawal.

An outpatient procedure is justified as a first attempt. To do this, the triggering drugs must be avoided. This can be supported by physical measures (cooling, rest, movement in the fresh air).

If the outpatient attempt is unsuccessful or problematic from the outset, only inpatient withdrawal remains. This should always be done in a specialized clinic, it usually lasts 10-14 days. The assumption of costs by the health insurance companies can be problematic for this.

If the withdrawal is successful, the patient remains with his primary headache in any case. This must then be treated professionally, otherwise the risk of relapse is very high.

forecast

Depending on the statistics, the relapse rate after successful withdrawal is one to two thirds within 1 to 5 years. Here, too, the close relationship to the addictions is obvious.

Complications of continued abuse of analgesics are, in particular, damage to the stomach ( gastric ulcer ) and the kidneys (analgesic-induced glomerulonephritis ).

swell

  • HC. Servant: headache and facial pain. 2nd Edition. Thieme, 2002.
  • Pschyrembel Clinical Dictionary. 259th edition. deGruyter.
  • K. Poeck, W. Hacke: Neurology. 11th edition. Springer, 2001, p. 427.
  • Marco Mummenthaler, H. Mattle: Basic Neurology Course. Thieme, 2002.
  • J. Klingelhöfer, M. Rentrop: Clinical Guide "Neurology, Psychiatry". Urban & Fischer, 2003, p. 249.

literature

  • Hartmut Göbel: The headache. 2., arr. and act. Edition. Springer, Berlin et al. 2004, ISBN 3-540-03080-8 . ( Scientific basis )
  • Hartmut Göbel: Successful against headaches and migraines. 4th, act. and additional edition. Springer, Berlin et al. 2004, ISBN 3-540-40777-4 ( patient guide )
  • V. Limmroth, Z. Katsarava, G. Fritsche, S. Przywara, HC Diener: Features of medication overuse headache following overuse of different acute headache drugs. In: Neurology. 2002 Oct 8; 59 (7), pp. 1011-1014. PMID 12370454 Neurology®
  • SD Silberstein, KM Welch: Painkiller headache. In: Neurology. 2002 Oct 8; 59 (7), pp. 972-974. Review. PMID 12370449 Neurology®
  • HC Diener, F. Antonaci u. a .: European Academy of Neurology guideline on the management of medication ‐ overuse headache. In: European Journal of Neurology. 27, 2020, pp. 1102-1116, doi : 10.1111 / ene.14268 .

Web links