Although the study subjects had 2.7 less headache days per month when they took the epilepsy drug, this was only a modest improvement over the 2.3 fewer headache days per month experienced by patients unknowingly taking the dummy pills, suggesting a placebo effect.
'Not a First-Line Choice'
A person who has 15 or more days with headaches per month or more than four hours per day for a period of at least six months meets the definition for chronic daily headache, regardless of whether they have migraines, tension headaches, or headaches due to another cause.
"In my opinion, [Neurontin] is not a first-line choice for preventing chronic daily headaches," headache specialist Stephen Silberstein, MD, tells WebMD. "This is one of the few studies ever done on a treatment to prevent daily headaches, so it was important to publish it. But it had a lot of flaws."
Silberstein outlined some of these flaws in an editorial published along with the study in the December issue of the journal Neurology. He noted that the researchers lumped all chronic daily headache sufferers together and did not diagnose which type of headache they were treating. Also, they failed to take into account the impact of frequent analgesic use. Patients in this study were not excluded if they were overusing analgesics.
The overuse of pain medications is now known to be a major cause of chronic daily headaches. Many medications used to treat headache pain, like certain analgesics, can cause even worse headaches to occur as they wear off. The cycle continues as sufferers take more and more medication, resulting in more and more frequent headaches. In fact adds, adds Silberstein, those who overused analgesics did worse.
This so-called rebound effect is present in as many as 80% of patients with chronic daily headaches, says Silberstein, who is director of the Jefferson Headache Clinic in Philadelphia.
Caffeine and Decongestants
Neurologist and headache specialist David Buchholz, MD, says some of the biggest headache-causing culprits include over-the-counter analgesics containing caffeine and decongestants in over-the-counter sinus drugs.
"These decongestant-containing drugs are a huge problem because so many people have headaches that they incorrectly attribute to sinus problems," he says.
He adds that narcotics and many other prescription drugs used to treat chronic headaches can also cause problems. Buchholz is an associate professor of neurology at Baltimore's Johns Hopkins Medical Institutions and has just published a book called Heal Your Headache.
Both experts say they consider Neurontin one of the least effective medications used to prevent chronic daily headaches. Silberstein had conducted prevention studies on the epilepsy drug Topamax. He considers this drug, along with the epilepsy drug Depakote and certain tricyclic antidepressants, to be the most effective prevention drugs available.
Buchholz says calcium-channel blockers can also help prevent headaches in certain patients.
The two experts disagree about the importance of foods as headache triggers. Buchholz says that a long list of foods -- including caffeine, chocolate, cheeses, nuts, MSG, alcohol, and even bananas and citrus fruits -- can bring on headaches, and he urges his patients to avoid them. Silberstein says that with the exception of alcohol, MSG, and caffeine, there is no scientific evidence linking foods with headaches.
"It is draconian to impose a long list of food restrictions on headache patients without scientific evidence to back it up," Silberstein says.