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nursefreed2
Oct 133 min read

Ow, my aching head. How to address rebound headaches.


Stress. Caffeine. Lack of caffeine. Medications. Dehydration. Lack of sleep. Poor diet. Alcohol... Headaches can be caused by multiple factors. Many types of treatment are available. Some include lifestyle changes (ie: lessen stressors, drink more water, get more sleep, eat a better diet, exercise), over-the-counter medications (ie: acetaminophen, ibuprofen, prescription options), and other holistic methods such as yoga & massage, all of which can be helpful. But did you know that overuse of headache medications can cause rebound headaches?


What are rebound headaches?

Also called medication overuse headaches, a rebound headache happens when headache medication is used too frequently. (1,2,5) You get a headache, you treat it, the headache returns, you treat it again, and so the cycle begins, thereby known as a 'rebound headache'. (2,5) Those considered at risk for rebound headaches have already been diagnosed with a headache disorder such as migraine or tension headache, have a headache for 15 or more days in a month, and are using at least one medication to stop the headaches for more than 3 months. (1,2,5) Many headache sufferers are using more than one medication in an attempt to get relief. Often, morning headaches and neck pain are reported. (2,5) Rebound headaches can lead to hypersensitivity of the skin, causing headaches to expand. (2) Additional systems may become involved, leading to symptoms such as a runny nose, tearing, nausea, vomiting, and /or diarrhea. (1,2,5)


Which medications are involved with rebound headaches?

Any medication that is taken frequently (nearly every day/multiple times weekly) for headache relief can be a problem. From over-the-counter drugs such as Tylenol, aspirin, and ibuprofen, to prescription medications such as Fioricet, triptans, and opioids, when used too frequently these meds can cause rebound headaches. (1,2,5)


What can be done to avoid rebound headaches?

While it is best to avoid the medications that may be causing the headaches it can be challenging if debilitating headaches need to be treated in order to function. And certain medications, such as opioids and anti-seizure medications (to name a couple) should not be stopped quickly but should be tapered and may require hospitalization with concern for withdrawal symptoms &/or seizures if these medications are suddenly discontinued. (5)


The first recommendation:

  • Speak to your primary care provider or neurologist in order to get an appropriate headache diagnosis and to create a treatment plan. (2,5)


Additionally:

  • You may be asked to keep a headache journal or diary in order to determine if certain foods or beverages, sleep patterns, stressors, or environmental exposures are contributing to your headaches. (5)

  • Discussions will also include your headache symptoms, how long you have had headaches, family history of headaches, your medical history (certain underlying diagnoses can be the source of headaches, such as depression, anxiety, chronic pain, post-traumatic stress disorder), medications you have tried, tobacco use, alcohol use, caffeine intake, substance use. (2,5)

  • Labs may be recommended. (5) Additional screening &/or testing such as for sleep apnea (polysomnography or PSG) may be ordered, as sleep apnea can cause morning headaches. (6)


Alternative headache management may be recommended.

These may consist of:

  • Sleep habit changes. Getting a consistent amount of sleep. (5)

  • Elimination diets to determine if certain foods/beverages are the cause. An elimination diet is when you stop eating/drinking a certain item, such as dairy or caffeine products, to see if by eliminating the suspected item, the headaches improve. (3)

  • Management of stressors (ie: relaxation techniques, increasing exercise, biofeedback) (5)

  • An alternative over-the-counter (OTC) option is oral magnesium. Studies have shown a correlation between migraines and magnesium deficiency. (4)

  • Medical providers may recommend the daily use of other prescription drugs to manage headaches, such as tricyclic antidepressants, anti-seizure meds, beta blockers, or calcium channel blockers to safely assist in controlling headaches while avoiding rebound headaches. (2,5) Botox injections may be another alternative treatment for migraines. (2)


Conclusion

Rebound headache patterns can be changed. If this article describes your struggle with recurrent headaches and frequent need for medications, know that you can help is available. Reach out to a medical provider and ask to discuss your frequent headaches and options to break the cycle. Also, remember it is a work in progress. Communicate with your medical provider what is helping and what is not working in order to continue to find a plan that works for you.



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