How to Avoid Rebound Headaches

What’s a "rebound headache"? Also known as medication overuse headache, it’s a common complaint among patients who treat their aching heads with analgesics, or pain relief drugs.

For people who take pain relievers for headaches on a very regular basis, the absence of the medicine can actually initiate a headache, according to Richard B. Lipton, MD, director of the Montefiore Headache Center, Edwin S. Lowe Professor, Vice Chair of Neurology, Professor of Epidemiology and Population Health, and Professor of Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine in Bronx, NY. "One headache trigger is the wearing off of medications taken to relieve headache," Lipton says. According to The New York Times, as many as 25 percent of all headaches are actually rebound headaches.

Some analgesics are more likely than others to produce medication overuse headaches: "Far and away the worst offenders are medicines that include barbiturates, such as codeine," Lipton says, adding, "Barbiturates and narcotics are found in some prescription medications taken to relieve headaches. It’s best not to take an acute medication [medicines used after the onset of symptoms] more than two or at most three days a week." Frequent use not only can cause rebound headaches, but "if overused, medication may become less effective."

Medication overuse doesn’t just cause headaches in people taking prescription pain relievers; over-the-counter drugs can trigger rebound headaches, too.

What You Can Do

There are several ways you can avoid rebound headaches:

  • Limit your use of pain relievers. The best way to prevent rebound headaches is to take prescription or over-the-counter pain relievers no more than two or three days a week. Of course, if you get headaches every day, this option has limited appeal, and according to the National Headache Foundation, if you stop using analgesics, your headaches may actually get worse for a brief period. But within a few days, symptoms usually improve. And if you’re a migraine patient, you should know that medications such as triptans (sumatriptan, rizatriptan or eletriptan), are better options than pain killers.
  • Take preventative medications. Unlike acute medicines, preventative medications are taken on a daily basis, even when you don’t have a headache. Preventative drugs for migraines include beta blockers (propranolol); tricyclic antidepressants (amitriptyline and nortriptyline); anti-epilepsy drugs (topiramate and divalproex sodium), and calcium channel blockers. If you are interested in a preventative regime, speak to your doctor.

Additionally, follow these guidelines to help lessen the number and severity of your headaches:

  • Learn to identify and avoid headache triggers. You can do this by keeping a headache diary—noting the foods, moods, time(s) of day, and situations that trigger your headaches. Common migraine and tension headache triggers include alcohol, chocolate, weather changes, nitrates, and nitrites; cluster headaches are often triggered by alcohol, head injury, or nitroglycerine.
  • Be healthy. "Eating regular meals, drinking enough water, getting sleep and physical exercise, managing stress, and avoiding headache triggers—all these lifestyle management activities can help prevent or lessen headaches," says Lipton.
  • Explore non-drug interventions. Relaxation techniques, including mental exercises, can help alter heart rate, blood pressure, breathing, and muscle tension to help reduce stress—a prime cause of headaches. Massage, especially trigger point therapy, and acupuncture may also be helpful.

Article reviewed by Richard Lipton, MD.

Sources

  1. Interview with Richard Lipton, MD
  2. Peter Jaret. "A Hidden Cause of Headache Pain." The New York Times, Aug. 30, 2007.
  3. "Diagnosing Migraine: Medication Overuse Headache." The Migraine Trust. Accessed July 3, 2014.
  4. "Rebound Headaches (or Medication Over-Use Headache)." Johns Hopkins Medicine. Accessed July 3, 2014.
  5. "Analgesic Rebound Headaches." National Headache Foundation. Accessed July 2, 2014.