‘Triptan’ Overuse Headache

July 1, 2009 by dean · Leave a Comment 

Neck structures contibuting to migraine

Neck structures contibuting to migraine

It is interesting to note that we now have another condition (or complication) in the headache and migraine industry – ‘Triptan Overuse Headaches’! This was always going to happen as it did with ‘Medication overuse headache’.

Whilst for many of my patients, the triptans were their best friend initially, eventually over time they were finding that they were needing to take another one in decreasing intervals, i.e. their effectiveness is decreasing or ….. perhaps it is that the cause of the sensitisation process is worsening.

It is imperative that the source of the sensitisation of the brainstem be determined.

Essentially the brainstem is influenced by four systems:

  • serotonin
  • diffuse noxious inhibitory control system
  • information from structures inside the head – blood vessels, teeth, gums, eyes, sinuses etc
  • information from structures of the upper neck – muscles, ligaments, capsules, joints etc

Of the above the easiest to confirm or eliminate is information from the neck.

Can you imagine how one of my patients who was experiencing migraine daily and who was taking Imigran (a triptan) three a times day for the past 10 years, felt when her migraine eased within 30 seconds after placing her head into a retracted (i.e. the opposite to a poking chin posture) position – she burst into tears! What a moment ….she realised her neck was contributing to her migraine.



(Créac’h C, Radat F, Mick G, Guegan-Massardier E, Giraud P, Guy N, Fabre N, Nachit-Ouinekh F, Lanteri-Minet M. One or Several Types of Triptan Overuse Headaches? Headache 2009;49(4);519-528

Limmroth V, Katsarava Z, Fritsche G, et al. Features of medication overuse headache following overuse of different acute headache drugs. Neurology 2002;59:1011-1014)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

About dean
Consultant Headache & Migraine Physiotherapist; International Teacher; Director, The Headache Clinic & Watson Headache Institute; PhD Candidate Murdoch University, Western Australia; Adjunct Lecturer, Masters Program, Physiotherapy School, University of South Australia; MAppSc(Res) GradDipAdvManipTher Experienced health practitioners trained in the Watson Headache Approach perform the examination and treatment techniques developed by Dean Watson. These techniques are based on his extensive experience of 7000 headache patients (21,000 hours) over 21 years and are now taught internationally. For your nearest practitioner who has completed training in the ‘Watson Headache Approach’ please refer to the ‘Practitioner Directory’.

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