A person who chronically uses analgesics may develop a headache that subsides when analgesics are discontinued. This is a problem for patients with chronic, recurrent headaches from other causes.


General criteria for chronic substance use/exposure headache:

(1) It occurs after taking daily doses of a substance for >= 3 months.

(2) The dose should exceed a required minimum dose (for analgesics, see below).

(3) The headache is chronic (>= 15 days per month).

(4) The headache disappears within 1 month after withdrawal of the substance.


Minimum dose for analgesics - one or more of the following:

(1) >= 50 grams of aspirin per month, or equivalent dose of NSAID

(2) >= 100 tablets per month of an analgesic combined with a barbiturate or other non-narcotic sedative

(3) >= 1 narcotic analgesics taken daily


The diagnosis can only be made after withdrawal of the analgesic results in relief from or improvement in (for patients with another cause for chronic headache) headaches.


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