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ARTICLES: Paul J. Spira and Roy G. Beran Gabapentin in the prophylaxis of chronic daily headache: A randomized, placebo-controlled study Neurology 2003; 61: 1753-1759 [Abstract] [Full text] [PDF]

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Gabapentin in the prophylaxis of chronic daily headache: A randomized, placebo-controlled study

R. A. Nash   (5 May 2004)

Reply to Nash

Roy G. Beran, P.J. Spira   (5 May 2004)

Gabapentin in the prophylaxis of chronic daily headache: A randomized, placebo-controlled study 5 May 2004
R. A. Nash 5589 Greenwich Road, Suite 175, Virginia Beach, VA 23462-6564 Send Correspondence to journal: Re: Gabapentin in the prophylaxis of chronic daily headache: A randomized, placebo-controlled study bob{at}doctornash.com R. A. Nash	I read with interest the article by Spira and Beran and the Silberstein’s Highlight and Commentary about chronic daily headache. [1,2] I wish to share my clinical perspective of chronic daily headache (CDHA) and my treatment protocol, which gives very successful results. I think that many headaches referred to as rebound headache or transformed migraine, are actually variants of fibromyalgia, consisting of recurrent muscle spasms and non-restorative sleep. Most CDHA are really a pain in the neck associated with an alpha-delta sleep disturbance. At delta sleep, the muscles relax maximally, the brain produces maximum amounts of endorphins and the autonomic nervous system (ANS) resets. CDHA patients have not slept deeply for months or years. A 13 question intake form assists me in ordering the correct antidepressant. [3] The form may be accessed online. [4] The following may interfere with the maximum production of the endorphins at delta sleep: alcohol, barbiturates, benzodiazepines and narcotics. Restoring alpha delta sleep patterns with the appropriate antidepressant, the avoidance of the four substances known to inhibit production of endorphins, with head and neck exercises and acupuncture , if needed, gives both the patient and the practitioner satisfaction. References 1. Spira PJ, Beran RG. Gabapentin in the prophylaxis of chronic daily headache. Neurology; 61: 1753-1759. 2. Silberstein, SD. December 23 Highlight and Commentary: Gabpentin in the treatment of chronic daily headache. Neurology 2003; 61: 1637. 3. Nash, RA. The Serotonin Connection. J of Orthomolecular Medicine 1996;11:35-44. 4. Doctornash.com [click on "Headache", then "How I treat chronic headache"]
Reply to Nash 5 May 2004
Roy G. Beran 12 Thomas Street, NSW 2067, Australia, P.J. Spira Send Correspondence to journal: Re: Reply to Nash roy.beran{at}unsw.edu.au Roy G. Beran, et al.	We are pleased to respond to the issues raised by Dr Nash regarding our article. [1] Dr Nash does not comment on the content of our paper but rather raises his own views of chronic daily headache (CDH). He presents multi- tiered hypotheses relating to the importance of fibromyalgia and non- restoratives sleep in the genesis of CDH. Evidence is not cited for these views nor for the efficacy of his chosen antidepressants. Were we to accept that efficacy, it is still unclear whether the benefit relates specifically to improvement in quality of sleep or modification of alpha delta sleep patterns. In our paper, we emphasize that in forming our beliefs regarding therapeutic efficacy of an agent, testing requires double blind randomized methodology. Dr Nash needs this level of examination of his hypotheses. [Please also see Correspondence from Dr. Beran regarding Silberstein Commentary] 1. Spira PJ, Beran RG. Gabapentin in the prophylaxis of chronic daily headache. Neurology; 61: 1753-1759.