Medication Overuse Headaches

Medication overuse headaches, sometimes called rebound headaches, happen when you take too many pain relievers for headaches, like migraines, over a long period. Regular pain relievers are great for occasional headaches. But if you take them more than a few times a week, they can actually cause headaches instead of relieving them.

This is especially true if you already have a headache disorder like migraines. Many pain relievers, even for things other than headaches, can trigger this problem in people who have a history of headaches. However, for people who haven't had regular headaches before, taking pain relievers regularly for another condition like arthritis doesn't seem to cause this kind of headache.

The good news is that these rebound headaches usually go away when you stop taking the pain medication. This might be tough at first, but it's important to talk to your doctor. They can help you find ways to manage the headaches in the long run and get off the pain relievers safely and effectively, without causing further problems.

Headaches caused by taking too much medicine can have different symptoms. These symptoms depend on the kind of headache the medicine was meant to treat and the medicine itself. A key sign of medication overuse headaches is that they happen:

• Frequently: These headaches often strike every day or almost every day. They might even wake you up early in the morning.
• Temporarily relieved by pain medicine: Taking pain medicine might ease the headache, but the pain typically comes back as soon as the medicine stops working.

You might also experience other symptoms like:

• Nausea: Feeling sick to your stomach.
• Restlessness: Difficulty staying calm or still.
• Difficulty concentrating: Having trouble focusing on tasks.
• Memory problems: Experiencing issues remembering things.
• Irritability: Feeling easily annoyed or upset.

These symptoms can vary from person to person. If you're experiencing headaches that fit this description, it's important to talk to your doctor. They can help determine if you're using pain medication too often and recommend ways to manage the headaches and prevent future problems.

Headaches are common, but it's crucial to take them seriously. Some headaches can be a sign of a serious health problem.

Get immediate medical help if you have a headache that:

• Starts suddenly and is very intense: A sudden, severe headache could be a sign of something more serious.
• Comes with other symptoms: If your headache is accompanied by a fever, stiff neck, skin rash, confusion, seizures, double vision, weakness, numbness, trouble speaking, or trouble breathing, seek immediate medical attention.
• Follows a head injury: Any headache after a head injury needs prompt evaluation.
• Doesn't get better with rest and over-the-counter pain relievers: If your headache persists or worsens despite resting and taking pain medicine, it's important to see a doctor.
• Is a new type of headache, especially if you're over 50: A new, persistent headache, particularly in older adults, warrants a visit to your doctor.
• Is worse when you're standing up and better when you're lying down: This unusual pattern could indicate a problem that needs medical attention.

Schedule an appointment with your doctor if:

• You have headaches frequently: If you have two or more headaches per week, it's a good idea to talk to your doctor. This could be a sign of a treatable condition.
• You use pain relievers often: Taking pain relievers for headaches more than twice a week might indicate a problem that needs to be addressed.
• You need more pain medicine than recommended: If you need a higher dose of over-the-counter pain medicine than the instructions suggest, you should see a doctor.
• Your headache pattern changes: If the frequency, intensity, or location of your headaches changes, it's time to talk to your healthcare provider.

Medication overuse headaches happen when you take too much medicine to treat headaches. Doctors aren't entirely sure why this happens, but some medicines are more likely to cause the problem than others.

Different types of headache medicines have varying risks:

Pain Relievers: Common pain relievers like aspirin and acetaminophen (like Tylenol) can contribute to overuse headaches, especially if you take more than the recommended amount. Ibuprofen (like Advil) and naproxen (like Aleve) have a lower risk of causing this type of headache.

Migraine Medicines: Many migraine medicines can be a problem if taken too often. These include triptans (like Imitrex) and some medicines called ergots (like ergotamine). A type of ergot called dihydroergotamine (like Migranal) might be slightly safer. A newer class of migraine medicines called gepants (like ubrogepant and rimegepant) seem less likely to cause overuse headaches.

Opioids: Strong painkillers like those derived from opium or synthetic versions, and combinations like codeine and acetaminophen, carry a high risk of overuse headaches. Prescription medicines containing butalbital (found in some headache remedies) also have a very high risk. It's best to avoid these medications for headaches if possible.

Caffeine: Daily caffeine intake, whether from coffee, soda, or even some pain relievers, can also contribute to medication overuse headaches. Be sure to check labels to understand how much caffeine you're consuming.

Important Note: The risk of medication overuse headaches varies from person to person. If you frequently use pain relievers or migraine medications, talk to your doctor. They can help you determine the best approach to managing your headaches and avoid potential problems.

Medication overuse headaches can happen when you take too many pain medicines for headaches. Here's what increases your chances:

• A history of frequent headaches: If you've had headaches for a long time, especially migraines, you're more likely to develop medication overuse headaches. This means headaches that occur regularly and often.

• Taking too many pain relievers: Using certain pain medicines frequently raises your risk. This includes combination pain relievers (like those containing ibuprofen and acetaminophen), opioid painkillers, medicines like ergotamine, and triptans (often used for migraines). Taking these types of medicines 10 or more days a month increases your risk. Even over-the-counter pain relievers like ibuprofen or acetaminophen, if used more than 15 days a month, can raise your risk. The risk is even higher if you've taken these medicines for three months or longer.

• Past substance use issues: A history of alcohol or drug abuse can also make you more susceptible to medication overuse headaches. This means having struggled with alcohol or drug problems in the past.

These factors don't guarantee you'll get medication overuse headaches, but they do increase your chances. If you have a history of frequent headaches and use pain medicines regularly, it's important to talk to your doctor about ways to manage your headaches safely and effectively.

Preventing Medication-Overuse Headaches

Medication-overuse headaches happen when you take too much pain medicine for headaches. It's important to prevent these headaches because they can be tough to get rid of and even cause other health problems. Here's how:

Medication Use:

• Follow instructions: Always take your headache medicine exactly as your doctor tells you.
• Limit use: If you need headache medicine more than twice a week, talk to your doctor right away.
• Be cautious with certain medications: Avoid taking medicines with butalbital or opioids unless your doctor says it's absolutely necessary. These types of pain relievers can contribute to overuse headaches if taken too frequently.
• Cut back on over-the-counter pain relievers: Use nonprescription pain killers for no more than 15 days each month.
• Limit strong headache medications: Keep triptans or combination pain relievers to a maximum of 9 days per month.

Lifestyle Changes:

Taking care of your overall health is a key part of preventing headaches.

• Identify your triggers: If you don't know what causes your headaches, keep a headache diary. Write down when, where, and how you feel before, during, and after each headache. This can help you spot patterns and figure out what might be setting them off.
• Get a good night's sleep: Aim for a regular sleep schedule. Go to bed and wake up around the same time each day, even on weekends. This helps regulate your body's natural sleep-wake cycle.
• Eat regularly: Skipping meals can lead to headaches. Try to eat a healthy breakfast, lunch, and dinner at roughly the same times each day.
• Stay hydrated: Drink plenty of water or other fluids without caffeine.
• Exercise regularly: Regular physical activity can help your body release chemicals that naturally block pain signals. Choose activities you enjoy, like walking, swimming, or cycling, and get your doctor's approval before starting a new exercise routine.
• Manage stress: Stress can trigger headaches. Try to find ways to reduce stress, such as organizing your schedule, planning ahead, and focusing on positive thoughts.
• Maintain a healthy weight: Obesity can be a factor in headaches. If you need to lose weight, work with your doctor to create a healthy plan that's right for you.
• Quit smoking: Smoking can increase your risk of medication-overuse headaches. If you smoke, talk to your doctor about quitting. There are resources and support available to help you.

By following these tips, you can help prevent medication-overuse headaches and enjoy better overall health. If you have persistent headaches, it's always best to consult with your healthcare provider for personalized advice.

Doctors can often tell if you have medication overuse headaches just by talking to you about your headaches and how often you take medicine. They'll look at your medical history and how frequently you use pain relievers, like aspirin, ibuprofen, or others. In most cases, no special tests are needed.

Managing Medication-Overuse Headaches: A Step-by-Step Guide

Medication overuse headaches happen when you take too much pain medicine. This can create a cycle where you need more and more medicine to get relief, leading to more headaches. To break this cycle, you need to reduce or stop the pain medication.

Reducing Your Medication:

Your doctor may recommend stopping the medicine suddenly or gradually lowering the dose. It's common for headaches to get worse before they get better as your body adjusts. This is called withdrawal. Withdrawal symptoms can include:

• Feeling anxious or restless
• Nausea and vomiting
• Trouble sleeping (insomnia)
• Constipation

These symptoms usually last for 2 to 10 days, but sometimes they can linger for a few weeks.

Managing Withdrawal Symptoms (Bridge Therapy):

To help with the discomfort of withdrawal, your doctor might suggest "bridge therapy." This involves using other medications to manage the headache pain and any withdrawal symptoms. These might include:

• Pain relievers like ibuprofen or naproxen
• Steroids
• Nerve blocks
• Drugs that constrict blood vessels (like dihydroergotamine, given intravenously).

There's some debate about how much help bridge therapy offers and which treatments work best. Withdrawal headaches typically improve within a week.

When to Consider a Controlled Environment:

If you're taking high doses of opioid pain relievers, sedatives, or other substances like tranquilizers, barbiturates, or opioids, your doctor may recommend a short stay in a hospital setting to safely manage the withdrawal process. This is especially important to prevent serious side effects.

Preventing Future Headaches:

To prevent the cycle from starting again, your doctor may prescribe preventive medicines. These are taken daily. Examples include:

• Anticonvulsants: Such as topiramate (Topamax, Qudexy XR, etc.)
• Beta-blockers: Such as propranolol (Inderal LA, Innopran XL, etc.)
• Calcium channel blockers: Such as verapamil (Calan SR, Verelan, etc.)
• CGRP monoclonal antibodies: These are injectable medications like Aimovig, Emgality, Ajovy, or Vyepti, designed to prevent migraine episodes. They're often given monthly or every three months.

These medicines can help you manage your headaches without relying on pain medications excessively. If you have future headaches, you can take pain relievers as directed by your doctor.

Other Ways to Manage Headaches:

• Botox: Injections of onabotulinumtoxinA (Botox) may help reduce the frequency and severity of headaches.
• Cognitive Behavioral Therapy (CBT): This type of therapy can teach you coping mechanisms for managing headaches and improve lifestyle habits. You'll also keep a headache diary.
• Complementary and Alternative Therapies: Therapies like acupuncture and certain herbs, vitamins, and minerals might provide relief. However, more research is needed on many of these. Always talk to your doctor about any complementary therapies you are considering. They may interact with other medications.

Support and Resources:

It can be helpful to connect with others who understand what you're going through. Your doctor can point you toward support groups in your area. You can also contact the National Headache Foundation for information and support (www.headaches.org or 888-643-5552).

Remember, this information is for general knowledge and does not constitute medical advice. Always consult with a healthcare professional for personalized guidance and treatment.