When medications that ease headache pain are used too often, these drugs can actually start causing headaches. Learn about prevention and treatment.
Medication overuse headaches or rebound headaches are caused by regular, long-term use of medication to treat headaches, such as migraines. Pain relievers offer relief for occasional headaches. But if you take them more than a couple of days a week, they may trigger medication overuse headaches.
If you have a headache disorder, any medication you take for pain relief can cause rebound headaches. Pain relievers taken regularly for another condition, such as arthritis, haven't been shown to cause medication overuse headaches in people who never had a headache disorder.
Medication overuse headaches usually stop when you stop taking pain medication. It's tough in the short term, but your doctor can help you beat medication overuse headaches for long-term relief.
Signs and symptoms of medication overuse headaches may differ according to the type of original headache being treated and the medication used. Medication overuse headaches tend to:
Other signs and symptoms may include:
Occasional headaches are common. But it's important to take your headaches seriously. Some types of headaches can be life-threatening.
Seek immediate medical care if your headache:
Consult your doctor if:
Doctors don't yet know exactly why medication overuse leads to rebound headaches. The risk of developing medication overuse headaches varies depending on the medication, but any acute headache medication has the potential to lead to medication overuse headaches, including:
Combination pain relievers. Over-the-counter (OTC) pain relievers that combine caffeine, aspirin and acetaminophen (Excedrin, others) are common culprits.
This group also includes prescription medications such as Fiorinal, which contains the sedative butalbital. Butalbital-containing compounds have an especially high risk of causing medication overuse headaches, so it's best not to take them to treat headaches.
Daily doses of caffeine — from coffee, soda, and pain relievers and other products containing this mild stimulant — may fuel medication overuse headaches, as well. Read product labels to make sure you're not wiring your system with more caffeine than you realize.
Risk factors for developing medication overuse headaches include:
To help prevent medication overuse headaches:
Taking care of yourself can help prevent most headaches.
Your doctor can usually diagnose medication overuse headaches based on a history of chronic headaches and frequent use of medication. Testing usually isn't necessary.
To break the cycle of medication overuse headaches, you'll need to restrict your pain medication. Depending on the drug you're taking, your doctor may recommend stopping the medication right away or gradually reducing the dose.
When you stop your medication, expect your headaches to get worse before they get better. Drug dependency may be a risk factor for drugs that result in medication overuse headaches, and you may have withdrawal symptoms such as:
These symptoms generally last from two to 10 days, but they can persist for several weeks.
Your doctor may prescribe various treatments to help alleviate headache pain and the side effects associated with drug withdrawal. This is known as bridge or transitional therapy. Treatments may include nonsteroidal anti-inflammatory drugs, corticosteroids or dihydroergotamine, an ergot that may be given through a vein (intravenously).
There's debate over how much benefit bridge therapy may offer, and whether or not one drug is more effective than others. Withdrawal headaches tend to improve in less than a week.
Sometimes it's best to be in a controlled environment when you stop taking pain medication. A short hospital stay may be recommended if you:
Preventive medications may help you break the cycle of medication overuse headaches. Work with your doctor to avoid relapsing and to find a safer way to manage your headaches. During or after withdrawal, your doctor may prescribe any of the following daily preventive medications:
These medications can help control your pain without risking medication overuse headaches. If you're careful, you may be able to take a medication specifically meant for pain during future headache attacks. Be sure to take medications exactly as prescribed.
Injections of onabotulinumtoxinA (Botox) may help reduce the number of headaches experienced per month as well as headache severity.
During this talk therapy, you learn ways to cope with your headaches. In CBT, you also work on healthy lifestyle habits and keeping a headache diary.
For many people, complementary or alternative therapies offer relief from headache pain. However, not all complementary or alternative therapies have been studied as headache treatments, and others need further research. Discuss the risks and benefits of complementary therapy with your doctor.
Possible therapies include:
You may find it helpful to talk to other people who've been through the same experience you're having. Ask your doctor if there are support groups in your area, or contact the National Headache Foundation at www.headaches.org or 888-643-5552.
You're likely to start by seeing your family doctor or a general practitioner. You may then be referred to a doctor who specializes in nervous system disorders (neurologist).
Here's some information to help you get ready for your appointment.
For medication overuse headaches, some questions to ask your doctor include:
Don't hesitate to ask any other questions.
The doctor will ask questions about your headaches, such as when they started and what they feel like. The more the doctor knows about your headaches and medication use, the better care he or she will be able to provide. Your doctor may ask:
Until your appointment, take your medication only as directed by your doctor, and take care of yourself. Healthy lifestyle habits — such as getting adequate sleep, eating plenty of fruits and vegetables, and getting regular exercise — can help prevent headaches. Avoid any known headache triggers.
A headache diary can be very helpful for your doctor. Keep track of when your headaches occur, their severity and duration, what you were doing when the headache began, and what your response to the headache was.
December 22nd, 2020