Analgesic headache

A common, treatable condition that deserves more attention

“Do no harm” is the first commandment for clinicians, but effective drug treatment cannot be given without exposing patients to the risk of side effects. One side effect quite often observed in the treatment of headache is rarely seen in other conditions: the treatment may aggravate the symptom for which it has been given. Ergotamine, narcotics, and even mild analgesics may all aggravate tension headache and migraine when taken daily.1 2

Ergotamine has a relatively short half life in plasma but a longlasting effect on arteries,3 and its frequent use may induce almost permanent vasoconstriction.4 Headache induced by ergotamine is of two types.5 One type is associated with daily use of ergotamine and is present almost constantly but fluctuates in intensity and characteristics: sometimes it fulfils the criteria for migraine, but at other times it does not. The second type is associated with sudden discontinuation of daily ergotamine, and this …