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Medication-overuse headache in patients with cluster headache

From the Headache Group, Institute of Neurology, Queen Square, London, UK (K.P., A.B., M.S.M., P.J.G.); Department of Neurology, Ghent University Hospital, Ghent, Belgium (K.P.); and Department of Neurology, University of Münster, Münster, Germany (S.E.).

Address correspondence and reprint requests to Dr Goadsby, Headache Group, Institute of Neurology, Queen Square, London WC1N 3BG UK; e-mail: peterg{at}ion.ucl.ac.uk

Objective: Medication-overuse headache (MOH) in cluster headache (CH) patients is incompletely described, perhaps because of the relatively low prevalence of CH.

Methods: The authors describe a retrospective series of 17 patients (13 men, 4 women) with CH who developed MOH in association with overuse of a wide range of monotherapies or varying combinations of simple analgesics (n = 9), caffeine (n = 1), opioids (n = 10), ergotamine (n = 3), and triptans (n = 14). The series includes both episodic (n = 7) and chronic (n = 10) CH patients.

Results: A specific triptan-overuse headache diagnosis was made in 3 patients, an opioid-overuse headache diagnosis was made in 1 patient, and an ergotamine-overuse headache diagnosis was made in 1 patient. In approximately half of the patients (n = 8), the MOH phenotype was a bilateral, dull, and featureless daily headache. In the other 9 patients, the MOH was characterized by at least one associated feature, most commonly nausea (n = 6), exacerbation with head movement (n = 5), or throbbing character of the pain (n = 5). The common denominator in 15 patients was a personal or family history, or both, of migraine. The 2 other patients gave a family history of unspecified headaches. Medication withdrawal was attempted and successful in 13 patients.

Conclusions: Medication-overuse headache is a previously underrecognized and treatable problem associated with cluster headache (CH). CH patients should be carefully monitored, especially those with a personal or family history of migraine.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 11 issue to find the title link for this article.

K.P. was supported by the Horlait-Dapsens grant (Brussels, Belgium).

Disclosure: The authors report no conflicts of interest.

Received July 7, 2005. Accepted in final form March 20, 2006.

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