Drug-induced refractory headache.

Two hundred patients who were taking daily symptomatic or immediate relief medications, often in excessive quantities, yet suffering from daily or near daily severe headaches were studied. One hundred and sixteen (58%) of them were also taking concomitant prophylactic medications and they were ineffective. Low-tyramine, low-caffeine dietary instructions and biofeedback training were given to all patients. The effect of continuing symptomatic medications, discontinuing symptomatic medications, and adding or changing prophylactic medications were studied in the various treatment groups. It is concluded that: (1) daily use of symptomatic or immediate relief medications results in chronic daily headache; (2) discontinuing daily symptomatic medication itself results in improvement of headache; (3) concomitant use of symptomatic medications nullifies the effect of prophylactic medications; (4) discontinuing daily symptomatic medications enhances the beneficial effect of prophylactic medications.