Drug- and caffeine-induced headaches
CMAJ 1997;157:510
See response from: W. Pryse-Phillips
The article "Guidelines for the diagnosis and management of migraine in clinical practice" (CMAJ 1997;156:1273-87 [full text / résumé]), by Dr. William E.M. Pryse-Phillips and associates, is an excellent overview. On the basis of my personal and practice experience, I would like to see more emphasis on the importance of drug-induced and caffeine-induced headaches. Anyone with frequent headaches (more than 2 per week) should be carefully questioned about intake of caffeine and use of over-the-counter and prescription drugs.
Acetaminophen and NSAIDs are the drugs least likely to cause headaches. Anything else needed to relieve headache pain (including sumatriptan) is prone to causing rebound headaches when withdrawn.
The initial management should involve identification and avoidance of triggers, careful and sensitive provision of information, the simplest single analgesic, rest, ice and massage. An appropriately informed patient can then be his or her own headache expert, detective and healer.
Philip E. Shea, MD
Hamilton, Ont.
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