Clonazepam for Refractory Headache: Three Cases Illustrative of Benefit and Risk

Morris Maizels, MD


Headache. 2010;50(4):650-656. 

In This Article


There have been no adequate scientific studies of the role of benzodiazepines in the prophylaxis of migraine or other primary headache disorders. Although open-label studies of clonazepam for chronic pain disorders have suggested a possible role, there is as yet insufficient evidence to support such a role. Further, to whatever extent benzodiazepines may ameliorate the pain experience, they may do so by reducing the emotional responses to pain. A case series of 3 patients with various primary headache disorders associated with some component of anxiety, insomnia, or somatoform symptoms is presented. These patients illustrate potential benefits as well as harm from the use of clonazepam. We suggest, while awaiting adequate scientific study, that clonazepam may be considered for the patient with headache refractory to standard therapies, with comorbid anxiety, insomnia, or somatoform symptoms, after adequate psychiatric evaluation has been performed, and with careful monitoring of drug use and outcomes.


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