8.2.1 Ergotamine-overuse headache

Identification: A 45-year-old female patient with a history of episodic migraine since adolescence reports a progressive worsening of headaches over the past 6 months. Current Illness History: She has been regularly using ergotamine tartrate (2 tablets/day) for at least 15 days per month over the past 3 months for symptomatic relief. She experiences daily or almost daily headaches (≥15 days/month) with variable characteristics (pulsatile/pressure), bilateral location, and moderate to severe intensity. The headaches worsen with ergotamine withdrawal and temporarily improve after taking a new dose. There are no other symptoms suggestive of secondary causes. Complementary Examinations: Neuroimaging (brain MRI) shows no abnormalities.