Headache: Preventive Medications for Chronic Daily Headache
by Lawrence Robbins, MD and Joseph Maides, DO
 Chronic daily headache
(CDH) is a common problem, affecting approximately 3 to 4% of the population.1
CDH poses a significant therapeutic challenge to both physician and patient.
For those with moderate or severe CDH, preventive medications are often utilized in an
effort to limit analgesics and decrease headache frequency and/or severity. The primary
first-line preventives include antidepressants (primarily selective serotonin reuptake
inhibitors and tricyclics) and anticonvulsants.2 Antidepressants have been as
attractive choice in those with comorbid depression and anxiety. Tricyclic antidepressants
have been known to have enhanced efficacy over SSRI’s, but are not as well tolerated.
The anticonvulsants sodium valproate and topiramate have emerged as effective drugs for
use in CDH.3
Other medications that have shown some benefit in CDH prophylaxis include beta
blockers, calcium channel blockers, NSAIDs, gabapentin, and muscle relaxants.
Unfortunately, due to a lack of efficacy and/or the presence of side effects, the
preventive medications are not always a useful long-term solution. The failure of the
preventives often frustrates physicians and patients. The purpose of this paper was to
retrospectively evaluate preventive medications in a large number of daily headache
patients.
Materials and Methods
Primary Objective and Endpoint: This study is a retrospective investigation of the
continuation rates for different classes of headache preventive medications. Overall,
headache relief, defined as at least 50% improvement in headache frequency and/or
severity, served as the primary endpoint.
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— June 2009
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