Magazine article Clinical Psychiatry News

Inpatient Treatment Is Start of Daily Headache Recovery

Magazine article Clinical Psychiatry News

Inpatient Treatment Is Start of Daily Headache Recovery

Article excerpt

CANCUN, MEXICO -- Many patients suffering from chronic daily headache have probably poisoned their receptors with medication overuse, and it may take weeks or months for them to recover fully, Dr. Joel R. Saper said at a symposium sponsored by the American Headache Society.

A complete cure is therefore not a realistic goal for the inpatient therapy for this condition. Rather, the goal of inpatient therapy should be to start the patient on the road to recovery, he said.

Moreover, recovery can be complicated not only by behavioral and psychological factors, but also by the predictable escalation of headache and the resulting emotional factors that typically result when weaning patients off their medications, said Dr. Saper, director of the Michigan Head-Pain & Neurological Institute, Ann Arbor.

The situation has changed greatly from the 1970s, when Dr. Saper began treating chronic daily headache. In those days the typical patient was overusing Cafergot, Fiorinal, or Excedrin, and a few days in the hospital really did leave them feeling much better. Nowadays, more and more patients are overusing powerful narcotics, and they may also be taking a laundry list of other medications that complicate recovery.

A case in point was one patient who had been hospitalized for the treatment of intractable headache and was being tapered off of 600 mg of OxyContin, Dr. Saper recalled. Instead of getting more agitated and experiencing increased pain during detoxification--which Dr. Saper would have expected--the patient began to appear unusually sedated.

A room search revealed that the patient had a bag full of other medications, including Demerol, that she was taking daily and had not mentioned to her treating physicians. (See photo.) The ampules, capsules, syringes, suppositories, and "suckers" consisted mostly of opioid preparations. "The patient admitted to taking these medications, plus those that we were administering for opioid reduction," Dr. Saper said.

Physicians at the institute use a number of criteria to decide whether to admit a patient with chronic daily headache. Most importantly, the headache must be moderate to severe, and it must have failed to respond to aggressive outpatient or emergency department services. The headache must require repetitive, sustained, parenteral treatment. …

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