DRUG-ABUSE AND HEADACHE

Substance abuse is a common problem encountered during the treatment of headache disorders. Prescription and over-the-counter agents are often used to excess, and some substances may result in rebound headache. Chronic daily use of analgesics, ergot compounds, caffeine, and short-acting barbiturates tend to promote a headache disorder refractory to treatment. Recent advances in understanding mechanisms of substance abuse, recognition of the problem, and assessment of the clinical status of the patient combined with the prophylactic treatment of migraine and tension headache can be most helpful in obtaining a satisfactory outcome. State-of-the-art measures necessary to deal with substance abuse in chronic headache are reviewed.