Patients with
chronic daily headache with
medication overuse are difficult to treat, especially when the doses of
analgesia are substantial. We have previously shown that intravenous
lignocaine (
lidocaine) infusion is useful in maintaining
pain control while the offending
analgesic agent is withdrawn in these patients. The published data on long-term efficacy of this treatment is limited. We undertook a retrospective survey of 71 consecutive patients admitted for
lignocaine infusion (mean 8.7 days) for treatment of
chronic daily headache, with substantial
analgesic abuse. Ninety percent of patients had a history of
migraine headaches. In 80% of patients
codeine was the predominant agent implicated in the
analgesic rebound headaches (mean 1053 mg/week) and 24% used
ergotamine-containing medications (mean 16 mg/week). Thirty-one percent frequently used injected
narcotics. At completion 90% reported that their daily
headache was absent or improved, and the
analgesic agent was withdrawn successfully in 97%. At six month follow-up, 70% of patients reported that their daily
headache was absent or improved and 72% of patients remained free of the offending
analgesic agent. Intravenous
lignocaine is a useful treatment in the management of chronic daily
headache with substantial
medication overuse. The benefits of the program last for at least six months.