Medication-overuse headache: citalopram associated with analgesics withdrawal as possible treatment

Medication-overuse headaches are a relevant medical and social problem, for which specific treatments have not yet been defined. In patients with chronic daily headache who take analgesics every day, this headache is most likely to be caused by drugs and will vanish with abstinence. Nonetheless, there is anecdotal evidence that selective serotonin reuptake inhibitors (SSRI) are effective in chronic daily headache, because of the concomitant presence of psychiatric comorbidities (depression, anxiety, or a combination of both). Six migraineurs were admitted to the Neurology Clinic for medicationoveruse headache and associated depression, anxiety and behavioural changes. Treatment consisted in suppressing other drugs and by using an SSRI, citalopram, at modest dosage (≤30 mg daily). Analgesic withdrawal was performed in hospital and was not particularly problematic. Over a 1-year follow-up, pain coping strategies ameliorated and depression decreased; drug withdrawal was easy, even from barbiturates, and pain control was good. Further investigation into the possible use of citalopram or other SSRIs in medication-overuse headache is waranted.