The Clinical journal of pain
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The recent development of new drug therapies for headache disorders has allowed for the tailoring of treatment to specific patient needs. This paper reviews the pharmacologic management of patients with both headache and concomitant medical illness. The discussion specifically includes the treatment of hypertension, coronary artery disease, mitral valve prolapse, asthma, peptic ulcer disease, obesity, and chronic Epstein-Barr virus infection, occurring concomitantly in patients with headache. Medications that can exacerbate either the headache or concurrent medical condition are noted, and alternative therapies are advised.
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An inpatient headache treatment unit provides a special environment for those patients whose headaches have failed to respond to outpatient therapy. Outpatient therapy may be precluded for a variety of treatment issues, including detoxification, initiation of copharmacy prophylactic medical therapy, and intravenous treatment for intractable chronic cluster headache and status migrainous headache. These complex medical treatments are viewed as some of the most valuable therapies by the patients and, at least in part, significantly decrease both headache indexes utilized in this survey. ⋯ Treatment failures may be due to variations in the etiology of chronic muscle contraction headache and posttraumatic headache. Denial of psychological factors in headache may also contribute to treatment failure. Habituation to analgesics and ergots may decrease patient response as compared with those not dependent.