Chronic headache and facial pain disorders are common. There are few trials of prophylactic treatment in these conditions, but several anticonvulsants have been shown to be effective. Anxiety is common in these patients, and pregabalin might therefore be useful if shown to be effective in reducing headache. In the absence of clinical trials, open-label data may be helpful in guiding clinical practice. 46 patients (35 F, 11 M) were given pregabalin for chronic and high frequency episodic headache disorders (n=38), and for neuropathic pain originating in trigeminal or occipital nerve territories (n=8). Maximum daily doses ranged from 25–600 mg daily. 36 patients had received previous prophylactic medications. 20/38 headache patients and 5/8 neuropathy patients reported improvement on pregabalin, pain being abolished completely in only two. 17/38 headache patients and 3/8 neuropathy patients reported no effect, but of these patients 11 stopped taking pregabalin within 4 weeks because of adverse effects. One patient whose headache was unaffected reported a significant decrease in anxiety. Two further patients who had benefitted from pregabalin also stopped it because of adverse effects. In total 25 patients reported adverse effects, the most common being drowsiness and gastrointestinal disturbance. In six cases paradoxical worsening of pain was seen at high doses. In summary, therefore, patients who tolerate pregabalin may find it helpful in reducing headache or facial pain.
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