Management of chronic daily headache utilizing a uniform treatment pathway

OBJECTIVE: To determine if the use of a uniform treatment pathway might be effective in treating patients with primary chronic daily headache. METHODS: Thirty-three consecutive patients with primary chronic daily headache were managed according to a treatment pathway which involved sequential administration of divalproex sodium, amitriptyline, amitriptyline plus phenelzine, or methadone. RESULTS: Twenty-two patients (67%) reported a 50% or greater reduction in headache days per month following initiation of treatment. Most positive treatment responses (17 [77%] of 22) were attributed to divalproex sodium. CONCLUSION: Implementation of a uniform treatment pathway may result in significant clinical improvement in a sizable proportion of patients with chronic daily headache.