By M. Wilkinson (auth.), Hans-Christoph Diener MD, Marcia Wilkinson MA, DM, FRCP (eds.)

M. WILKINSON sufferers with widespread or day-by-day complications pose a truly tough challenge for the health professional who has to regard them, rather as many sufferers imagine that there will be a drugs or medications which offer them rapid aid. within the look for the compound which might meet this very average wish, many medicinal drugs were synthetic and the temptation for the general practitioner is both to extend the dose of a drug which appears to be like, at any price, in part potent, or so as to add a number of medicines to these which the sufferer is already taking. even supposing there were a few references to the risks of overdosage of substances for migraine some time past, it was once no longer until eventually fairly lately that it used to be famous that medications given for the relaxation of headache, if taken injudiciously, may well themselves reason headache. the 1st medicinal drugs to be implicated during this manner have been ergotamine and phenazone. in relation to ergotamine tartrate, the hazards of ergotism have been popular as this was once a disease which have been identified and written approximately for a few years. within the remedy of headache, totally blown ergotism is unusual and in recent times has frequently been because of self-medication in doses a lot more than these prescribed even though there are a couple of recorded circumstances the place poisonous quantities were given.

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It is maintained by a sometimes almost careless use of analgesics, by the patients fear of the next attack and finally by his addiction to the barbiturates and opioids contained in the compound preparations (Worz 1983; Dichgans et al. 1984; Rapoport 1984). After a period of habituation due to the psychotropic effects of barbiturates and opioids, a psychophysical dependence results, which might be enhanced in individual cases by an abuse of tranquilizers. The patients attitude toward drugs is also influenced by the drug experience of headache sufferers in his close environment (Tfelt-Hansen 1985).

5. The headache duration in prophylactic treatment with DHE in a group of migraine patients is plotted as the percentage of the headache duration during an 8-week baseline period. The study is explained in more detail in Results. An initial minor decrease in headache duration during month 1 of treatment changes into a considerable increase in headache duration in months 5 and 6. This effect is interpreted as indicating the development of headache under chronic intake of DHE and a maximum of 42 g.

Diener and M. Wilkinson if) Springer-Verlag Berlin Heidelberg 1988 What Kind of Drugs Are Taken by Patients with Primary Headaches? 45 - After regression of the withdrawal headache, the primary headache persists unchanged. If adequate prophylaxis is not introduced concomitantly, self-administration will soon recommence (Kudrow 1982) Thus, the successful treatment of a patient with an analgesic-induced headache depends on the knowledge of the mechanisms which induce and maintain the pain and moreover requires that the patient has full medical information.

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