HEADACHE PATIENTS WITH MULTIPLE MEDICATION SIDE-EFFECTS

Objective. To describe a type of headache patient who has an unusual number of side effects to commonly prescribed medications. Design. Five case studies are reviewed. Setting. Patients were seen in an outpatient headache clinic over a one year period. Patients. All patients had chronic headaches and normal neurologic examinations. Main Outcome The probability of these side effects occurring Measures. in any one patient was calculated. The results were extremely low, suggesting that factors other than chance must have been operating. Possible explanations include a negative placebo effect, a conditioned response to medication, and a neurochemical reaction resulting in side effects. Conclusion: Attention to psychologic issues resulted in improvement in three patients, and was felt to be crucial in the other two. Clinicians should recognize that patients with multiple medication side effects may have psychological conflicts, and are unlikely to respond to further attempts at medication tretment.