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(or Medication Over-Use Headache)
One of the most common causes of a chronic daily headache, rebound headaches are caused and perpetuated by patients’ too frequent use of short-acting pain medications. If used indiscriminately, the very medications taken to make headaches better can actually make them worse, resulting in the headaches becoming both more frequent and more resistant to treatment. Medication over-use headaches are seen very frequently in headache centers, and are notoriously difficult to treat.
How do rebound headaches begin?
A typical scenario involves a patient with intermittent migraines who discovers a short-acting medication helpful in relieving their pain symptoms. They begin taking the medication more often, and begin to develop more frequent headaches, requiring more doses of the medicine, resulting in still more headaches. Eventually, they become dependent upon the medicine, taking it on a daily basis just in order to “get by”, all the while suffering a headache that is there almost all the time, relieved only briefly after each dose. Attempts to stop the medication results in a withdrawal headache that’s even more painful — and the patient is “stuck” in a vicious cycle where the pills that seem to help are the same pills that are causing the problem. If only the cycle could be broken, the headaches would substantially improve.
The headaches themselves typically range in symptoms somewhere between a tension headache and a migraine, sometimes with severe exacerbations.
Previously termed “rebound headaches”, these frequent headaches may improve dramatically if the offending short-acting medications can be weaned off or discontinued — a process that is often painful and difficult to do.
Common culprits in rebound or medication over-use headaches include over the counter remedies and prescription medications such as narcotics or triptans. While these medications are all effective at treating individual headaches, when taken in excess they often make matters worse rather than better. They are designed to treat the occasional headache, not to be taken on a daily basis.
How are rebound headaches treated?
While outpatient treatment with preventive therapy and gradual withdrawal of the offending drugs is often helpful, sometimes the headaches are so severe that treatment essentially requires inpatient “detox.” The Johns Hopkins Headache Center admits appropriate patients to Johns Hopkins Bayview neurology inpatient service. We also have psychologists who can assist these patients in improving their counter-productive pill-popping behaviors.
If you are taking medications to treat your individual headaches 10 or more days a month and are experiencing headaches more often than not, it is likely that you are suffering from medication over-use headaches. There is little chance of improvement until you stop over-using your medications, no matter what else your provider prescribes. Unfortunately, this usually means that you will feel worse for a few weeks before you make any substantial improvement.
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