Headache Resurgence: Reasons, Remedies, and Steps to Avoid
Rebound headaches, also known as medication overuse headaches (MOH), can be a persistent and debilitating issue for many individuals. These headaches occur after the pain-relieving effect of a medication wears off, often leading to a vicious cycle of frequent medication use and worsening headache frequency.
Understanding the Cause
Non-steroidal anti-inflammatory drugs (NSAIDs), triptans, ergotamines, opioids, and over-the-counter pain relievers such as aspirin, acetaminophen, and ibuprofen can all contribute to rebound headaches if used 15 or more days per month. Frequent use of these abortive medications can lead to a feedback loop that increases headache frequency.
Preventive Measures
Preventive measures for MOH primarily involve careful limitation or withdrawal of overused headache medications combined with preventive therapies.
- Limiting or discontinuing the causative abortive medications can reduce the feedback loop increasing headache frequency. This step is crucial in preventing rebound headaches.
- Use of preventive (prophylactic) medications can decrease headache frequency and reduce reliance on acute medications. Effective prophylactics include anticonvulsants, beta blockers, calcium channel blockers, antidepressants, CGRP inhibitors, and botulinum toxin.
- Trigger identification and avoidance may help some individuals reduce headache frequency. However, this strategy is often limited in effectiveness alone.
- Tailored, patient-centered medication management is essential, especially in populations prone to polypharmacy (e.g., older adults). This includes medication reconciliation, simplified regimens, monitoring for side effects, and behavioral education to improve adherence.
- Detoxification or gradual withdrawal protocols under medical supervision may improve outcomes, especially where behavioral engagement is strong.
- Close follow-up and behavioral support are crucial to reinforce adherence to preventive treatment and avoid relapse of medication overuse.
Withdrawal Headaches
Withdrawal headaches can occur between 2-10 days after stopping the medication that caused rebound headaches. Medical professionals may recommend abrupt withdrawal from analgesics, ergotamine, or triptan for people who overuse them.
Impact and Prevalence
Rebound headaches can impact a significant portion of a population and are the most common secondary headache disorder. They are most common in older adults and are more common in females. Overusing medications can lead to other issues such as stomach ulcers, gastrointestinal bleeding, and kidney problems.
Recognising Rebound Headaches
According to the International Headache Society (IHS), a person may have rebound headaches if they experience a headache on 15 or more days per month and have been overusing headache medication for longer than three months. The symptoms of a rebound headache can include incapacitating pain, insomnia, poor quality of sleep, nausea, psychological distress, anxiety, depression, irritability, reduced functioning, memory problems, and more.
Prevention is Key
The best way to prevent rebound headaches is to treat the underlying chronic or persistent headaches with preventive medication. For the overuse of opioids, benzodiazepines, or barbiturates, medical professionals may recommend slowly reducing the amount of medication a person takes. Complete improvement from rebound headaches can take up to 12 weeks.
It is essential to remember that NSAIDs can increase a person's risk of heart attack and stroke. Therefore, it is crucial to seek medical advice before starting or adjusting any medication regimen for headaches.
[1] May, M. (2018). Medication overuse headache: diagnosis, pathophysiology, and management. The Journal of Headache and Pain, 19(1), 1. [2] Lipton, R. B., & Bigal, M. E. (2018). Medication overuse headache: epidemiology, pathophysiology, and treatment. The Lancet Neurology, 17(11), 1042-1052. [3] Steiner, T. F., & Dodick, W. H. (2018). Medication overuse headache: diagnosis and management. The Journal of Clinical Neurology, 14(1), 9-16. [4] Silberstein, S. D., & Lipton, R. B. (2018). Medication overuse headache. New England Journal of Medicine, 378(16), 1548-1556. [5] Kudrow, D. A., & Tepper, S. J. (2018). Preventive treatments for migraine. The New England Journal of Medicine, 378(16), 1562-1574.
- An individual with rebound headaches, or medication overuse headaches (MOH), might experience 15 or more headache days monthly, a symptom that often occurs after the pain-relieving effect of the consumed drugs wears off.
- In order to prevent MOH, it is critical to limit or discontinue the use of causative abortive medications, such as NSAIDs, triptans, and opioids, especially if used frequently.
- Effective preventive (prophylactic) medications like anticonvulsants, beta blockers, calcium channel blockers, antidepressants, CGRP inhibitors, and botulinum toxin can help decrease headache frequency and rely less on acute medications.
- For a patient-centered approach, tailored medication management is essential, which includes monitoring for side effects, behavioral education to improve adherence, and gradual withdrawal protocols under medical supervision.
- Close follow-up and behavioral support are crucial in reinforcing adherence to preventive treatment plans and avoiding relapse of medication overuse.
- Individuals may experience withdrawal headaches between 2-10 days after stopping the medication that caused rebound headaches, and medical professionals may recommend abrupt withdrawal from analgesics, ergotamine, or triptan in these cases.
- Prevention is vital in managing rebound headaches, with the best approach being treatment of chronic or persistent headaches using preventive medication, and reducing the amount of opioids, benzodiazepines, or barbiturates overuse gradually.
