Abstract
Dear sir In their article on prednisolone as the initial treatment of analgesic-induced daily headache, published in Cephalalgia 2000; 20:107–13, the authors gracefully omitted reference to their source of knowledge with regard to the treatment they studied. This reference is to Spierings ELH, 1995, personal communication. The aspects of abrupt discontinuation of analgesic use and providing the patients with the proper information are found in Spierings ELH, Headache; Boston: Butterworth-Heinemann, 1998:110. The 6-day course of prednisone as described by the authors (60 mg/day for 2 days; 40 mg/day for 2 days; 20 mg/day for 2 days) is based on the 3-day prednisone course developed by John Ruskin Graham MD, MACP, for the treatment of migraine status and is described in the same book on page 121. A description of the usage of the 3-day prednisone course for the treatment of acute analgesic discontinuation can be found in Chapter 44, entitled ‘The woman with continuous headache’, in: Rapaport AM, Sheftell FD, Purdy RA, eds; Advanced Therapy of Headache; Hamilton, Canada: BC Decker, 1999:141–45. A full description of the treatment can also be found in Spierings ELH, ‘Diagnosis and treatment of headache’, in: Stoudemire A, Fogel BS, Greenberg DB, eds; Psychiatric Care of the Medical Patient; Oxford: Oxford University Press, 2000:654–70.
ELH Spierings, Associate Clinical Professor, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
Dear sir This letter is an expression of gratitude, acknowledgement and regret. Gratitude to Dr Egilius Spierings who was responsible for suggesting to me, for the first time, to use prednisone as an out-patient option for detoxification of chronic daily drug-induced headache. In 1995, when he was in Rio for a meeting, I had the honour of seeing some patients with him and the suggestion came out after we saw a group of refractory patients. Acknowledgement, because I think it is important for everyone to know that he was the one that did teach me to do it. Finally, regret, since I did not know I could have used his personal communication as a reference for the paper, and also because I simply forgot to mention it in the Acknowledgements.
At that time, and seeing as of today mostly refractory daily headache patients, I was using the gradual tapering of ergotamine and other overused symptomatic medications, and still had difficulties with regard to headache escalation and withdrawal symptoms. After his comments, I started to use the prednisone and in 1997 decided to perform a prospective study which resulted in the above mentioned article.
I hope this letter, even though late, makes proper and fair recognition of his help and guidance.
A Krymchantowski, Director, Headache Centre of Rio, Rua Siqueira Campos 43, 1002 Copacabana, Rio de Janeiro, Cep: 22031 070, Brazil