An article in the current issue of Neurology demonstrates that Gabapentin may be useful in the treatment of daily chronic headaches:
A total of 133 patients were enrolled (41 men, 92 women, mean age 43 years). All were eligible for safety analysis. Ninety-five received sufficient treatment to allow evaluation of efficacy. There was a 9.1% difference in headache-free rates favoring GPT over placebo (p = 0.0005). Benefits for GPT were also demonstrated for headache-free days/month (p = 0.0005), severity (p = 0.03), VAS (p = 0.0006), headache-associated symptoms of nausea (p = 0.03) and photophobia/phonophobia (p = 0.04), disability affecting normal activities (p = 0.02), attacks requiring bed rest (p = 0.001), and QOL related to bodily function (p = 0.01), health/vitality (p = 0.0001), social function (p = 0.006), and health transition (p = 0.0002). Reduction in headache days/month was seen across the spectrum of prerandomization headache frequencies.
This looks like a well designed study. I've used it a few times for patients in this situation – but I wouldn't say that I have considered it first line. The treatment of a problem depends on the cause fo that problem — and chronic headaches can be caused by many many things. Is the use of gabapentin just masking the symptoms – or treating the problem? Hard to know.