What are rebound headaches? How to break the cycle

Here’s the scenario: You have a nasty headache, so you pop your over-the-counter (OTC) pain medication of choice. Your headache improves, and you’re happy that you don’t feel as bad as you did before you took it. But then, you get a headache the next day, so you take it again. And so on. What’s happening?

“Yes, you can have too much of a good thing,” said Avery Saporito, MD, neurologist on the medical staff at Baylor Scott & White – Dallas. Although over-the-counter pain medications can be helpful, if you take them too often, you might find that these common medicines actually start causing your headaches instead of relieving them. And you just may have entered the cycle of rebound headaches.

What are rebound headaches?

Rebound headaches, also known as medication overuse headaches, are headaches that can be intense and occur frequently, even if you only used to have occasional headaches. The culprit behind these headaches is often the excessive use of pain relievers, both OTC and prescription medications. Surprisingly, the very medications intended to alleviate your pain can end up causing more headaches. In fact, taking headache medication more than 10 days per month can set you up for medication overuse headaches (MOH).

What causes medication overuse headaches?

Several factors can trigger medication overuse headaches:

• Using OTC pain relievers like acetaminophen, ibuprofen or aspirin too frequently
• Consuming combination analgesics containing caffeine or butalbital regularly
• Relying on opioids or ergotamines (a prescription medication used to treat migraines and cluster headaches)

It's worth noting that rebound headaches can occur with many types of medication used to treat headaches as needed and that the primary cause of rebound headaches is the overuse of acute headache medications.

While the exact reason is not fully understood, frequent use of these medications can disrupt normal pain pathways in the brain, leading to rebound headaches.

What is the difference between rebound headaches and migraines?

It's important to note that rebound headaches are distinct from primary headache disorders like migraines or tension headaches, which have their own triggers and causes.

Distinguishing rebound headaches from other headache disorders is crucial for effective treatment. Rebound headaches often exhibit specific characteristics that set them apart from migraines or tension headaches, but it is often difficult to differentiate without the help of a professional.

Your healthcare provider will carefully analyze your medical history and your symptoms, including frequency, duration and response to medications, to make an accurate diagnosis. Many people may have initially had only migraine or tension headaches, however, by overusing as-needed medications can also develop additional medication overuse headaches.

How to avoid medication overuse headaches

When used appropriately, over-the-counter medications are quite helpful. The problem becomes knowing what the definition of “appropriate use” really means.

From a headache standpoint, over-the-counter medications such as acetaminophen, naproxen, ibuprofen and aspirin should be limited to 10 days per month, which equates to two to three days per week of use. However, this does not mean you get 10 days of each medication. Rather, it is 10 days a month combined. Otherwise, you get into this ugly cycle of more headaches, so you take more medication, which then causes more headaches, so you take more medication, and it becomes a vicious cycle.

It’s important to note that over-the-counter medications are not the only culprits of medication overuse headaches. Caffeine and prescription medications can lead to headaches too, including prescription nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and narcotics to name a few.

How to treat or stop medication overuse headaches

So, what do you do if you think you are experiencing medication overuse headaches?

Unfortunately, the only way to stop the vicious cycle is to stop use of the medication and completely eliminate it from use for about six to eight weeks.

It is important to note, however, that although some medications can be stopped “cold turkey,” others may need to be weaned slowly with a gradual withdrawal or even medication rotation. Scheduling an appointment with a healthcare provider is the best way to figure out the best way to “wash out” from the medication overuse, while managing your pain.

If there is an additional underlying primary headache disorder, your provider may discuss an alternative way to treat this that does not cause rebound headaches.

“We try to decipher the initial headache type and start alternative treatment that does not contribute to rebound. Addressing the underlying problem often makes the transition off frequent acute medications smoother,” Dr. Saporito said.

So, what can you do while you are waiting for your appointment? Here are a few ways to minimize your headaches in the meantime:

• Limit caffeine to no more than 100mg per day only two or three days per week. Zero caffeine is best, but take care to reduce your consumption slowly, by about 100mg per week.
• Maintain a regular sleep schedule—go to bed and wake up at the same time every day.
• Do not skip or miss meals. At least grab a small snack.
• Drink plenty of water. Dehydration can trigger headaches, so make sure to drink an adequate amount of water throughout the day.
• Exercise. After approval from your healthcare provider, start exercising and build up slowly to a goal of 150 minutes per week.
• Practice stress management techniques, such as meditation, relaxation exercises or even a new hobby.
• Stop smoking.

And definitely try your best to avoid your headache triggers, such as trigger foods, alcohol or strong smells.

Ultimately, the best way to avoid the cycle of medication overuse headaches is to prevent it by taking medication thoughtfully and tracking your days of use. If at the time of reading this, you have more than 4 headache days per month, you should schedule an appointment with your doctor.

“When people need to reach for an as-needed medication more than once per week, it may be time to start a preventative medication. These are aimed to stop the headache from starting in the first place,” Dr. Saporito said.

For assistance in finding the right provider and tools to navigate effective rebound headache relief, learn more about our Virtual Headache Care program.