For the past few years, I have experienced an occasional migraine. Lately, I have been experiencing more frequent migraine with symptoms of extreme pain on one side of the head and sensitivity to light and noise (iPads off, kids!).
Usually, I’d reach for a bottle of Excedrin Migraine and lay down to rest. In an hour, I would be good as new. That was when I had two or three migraine days a month. Now, I’m experiencing up to ten migraine days per month. Because of the risk of rebound headache, I’m not so quick to reach for the Excedrin Migraine.
What are Rebound Headaches?
When you get a headache or migraine, you might take an over-the-counter (OTC) or prescription medication to try to stop the pain. This may be an effective strategy to combat the pain and other associated migraine symptoms.
However, if you take more medication (we’ll get into amounts shortly) than the label (or your healthcare provider) recommends, you may rebound into another headache. Rebound headaches are also called medication overuse headaches.
Unfortunately, a cycle can develop. You have a migraine, take a pain reliever, get a rebound headache, and take more medication. The cycle can continue until you suffer from more and more headaches.
What Medications Cause Rebound Headaches?
According to the American Migraine Foundation, medication overuse is defined by how much acute medication (medication used to stop a migraine, as opposed to preventing one) you take per month.
- Simple analgesics (single-ingredient products such as aspirin, acetaminophen, ibuprofen, or naproxen) can contribute to rebound headaches if you exceed the recommended daily dosage or use them for 15 or more days per month.
- Combination pain medications (such as OTC Excedrin Migraine or prescription Fioricet) containing several ingredients including caffeine, aspirin, acetaminophen, or butalbital may cause rebound headaches if taken for ten or more days per month.
- Triptans/ergotamines may lead to rebound headaches if used for ten or more days per month.
- Opioids such as oxycodone, tramadol, morphine, codeine, or hydrocodone can cause rebound headaches when used for ten or more days per month.
- Caffeine intake over 200 mg daily can increase the risk of rebound headaches.
*Note: butalbital (found in Fioricet, Fiorinal) or opioids should only be used as a last resort in treating migraines.
What are the Symptoms of Rebound Headaches?
Although symptoms and severity vary, rebound headaches may occur daily (or almost every day). These headaches frequently occur first thing in the morning, often waking you up. With the cycle described above, you may reach for a pain reliever and feel better, but the pain soon returns.
Besides pain, other symptoms of rebound headache include nausea, anxiety, irritability, lack of energy, restlessness, difficulty concentrating, memory problems, and depression.
How are Rebound Headaches Diagnosed?
Your healthcare provider can usually diagnose rebound headaches clinically by looking at medication use and headache frequency. He or she may also order imaging studies or lab work if necessary.
How Common are Rebound Headaches?
Rebound headaches occur in one or two out of every 100 people. These headaches are more common in women than in men. Patients with chronic pain, depression, or anxiety are more likely to experience medication overuse headaches.
What is the Treatment for Rebound Headaches?
Rebound headaches will worsen until you are adequately treated, so it’s essential to see a headache specialist.
Your specialist will likely prescribe preventive medications. He or she may also prescribe prescription drugs to treat a migraine when it occurs. At the same time, your doctor will instruct you on how to stop or taper off the medication(s) that were causing rebound headaches.
Patients on larger doses of sedative medications or narcotics may need to be detoxified in the hospital.
The first few weeks of your new regimen may lead to increasing headaches, so it is important to be closely supervised by your specialist. Keeping a record of your symptoms, frequency, and duration will help your specialist as well.
Eventually, with proper treatment, the rebound headaches will stop, and you will just have your “normal” headaches. But, hopefully, the preventative medications will decrease the frequency and severity of your migraine.
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How can I Prevent Rebound Headaches?
Here are some tips to prevent rebound headaches:
- Limit the use of pain relievers (see above for doses that cause rebound headaches).
- If you need to take headache medications more than two days per week, see a headache specialist. You may need preventive medicine and a treatment plan, depending on frequency and severity.
- Avoid butalbital (Fioricet, Fiorinal) or opioid pain relievers (such as oxycodone or hydrocodone) except when prescribed as a last resort by your healthcare provider.
- Note: DO NOT stop taking any medications prescribed to you by your provider without consulting them first*
- Identify and control triggers (see below for more about triggers).
- Note: DO NOT stop taking any medications prescribed to you by your provider without consulting them first*
What are Some Other Tips to Prevent Migraine?
In addition to following the treatment regimen prescribed by your headache specialist, you can try these tips to avoid migraine:
- Sleep: Keep a regular sleep schedule, even on the weekends. Go to sleep and wake up around the same time each day. Avoid naps (they can interfere with nighttime sleep) or keep them short.
- Eat: Eat regular meals (don’t skip!) and drink plenty of water. Keep a food diary to help identify trigger foods. Avoid common trigger foods such as chocolate, aged cheese, alcohol, and caffeine (your trigger foods may vary; if it is not a trigger, you don’t have to avoid it).
- Exercise: Regular exercise helps pain and can also help symptoms of depression and anxiety. Exercise can help you maintain a healthy weight.
- Manage stress: Try relaxation or yoga. Take time to do things you enjoy.
- Keep track: A migraine journal can help you identify patterns or triggers. There are many apps you can find if you prefer to track electronically.
- Seek support: Find help through counseling, a support group, or even a social media support group (Only take medical advice from your healthcare professional).
Bottom Line
- If you are experiencing rebound headaches, seek proper treatment so you can be on your way to feeling better soon!
- Use a headache diary to keep track of symptoms, triggers, medication use, and headache pain/resolution to help your healthcare provider assist you in management of your migraines
- If you notice the frequency of your migraines increasing, make sure to let your healthcare provider know so you can determine a more appropriate treatment plan and avoid rebound headaches before they begin
References
- Headaches: Rebound Headaches. Cleveland Clinic website. https://my.clevelandclinic.org/health/diseases/6170-headaches-rebound-headaches Accessed August 25, 2020.
- Medication Overuse Headache. American Migraine Foundation website. https://americanmigrainefoundation.org/resource-library/medication-overuse/ Accessed August 25, 2020.
- Five questions for choosing a treatment for severe migraine relief. American Academy of Neurology website. https://www.aan.com/siteassets/home-page/policy-and-guidelines/quality/quality-improvement/patient-handouts/13migrainereliefsdmtool-pg.pdf Accessed August 25, 2020.
- Stopping the vicious cycle of rebound headaches. Harvard Health Publishing Harvard Medical School website. https://www.health.harvard.edu/blog/stopping-the-vicious-cycle-of-rebound-headaches-2019110718180#:~:text=Medication%20overuse%20headache%20is%20a,who%20have%20depression%20and%20anxiety. Accessed August 25, 2020.
- Headaches: Rebound Headaches: Management and Treatment. Cleveland Clinic website. https://my.clevelandclinic.org/health/diseases/6170-headaches-rebound-headaches/management-and-treatment Accessed August 25, 2020.
- Migraine: Simple steps to head off the pain. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/migraine-headache/in-depth/migraines/art-20047242 Accessed August 25, 2020.
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Chris is one of the Co-Founders of Pharmacists.org. An entrepreneur at heart, Chris has been building and writing in consumer health for over 10 years. In addition to Pharmacists.org, Chris and his Acme Health LLC Brand Team own and operate Diabetic.org and the USA Rx Pharmacy Discount Card powered by Pharmacists.org.
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