Headache Headache Treatment

Rebound Headache: When Medication Backfires

It's a paradox, but one that may be familiar to you: despite regular use of pain relievers for migraine, you suffer from headache each and every day--perhaps even more than before you used these medicines. This phenomenon, known as "rebound headache," affects many with chronic headache who regularly take medicines for acute pain (so-called "abortive" medications, as opposed to "preventive" therapies which do not typically cause rebound). Rebound is caused by the overuse of abortive medications such as analgesics (pain killers), barbiturates (in Fioricet), caffeine, and ergotamine tartrate (in Wigraine). The big question: how much pain killer use is overuse?

Analgesic Rebound Headache
The typical sufferer of rebound headache comes to rely on increasingly frequent and higher doses of pain killers to keep a headache at bay. Over time, headache symptoms grow worse rather than better, despite large amounts of prescription drugs, or off-the-shelf pain relievers containing aspirin, acetaminophen, ibuprofen, ketoprofen, naproxen sodium, or caffeine (see separate caffeine section, below). Other offenders include sinus medications containing phenylpropanolamine or similar blood-vessel constricting drugs.

Worse still: overuse of pain relievers may reduce the effectiveness of medications prescribed for daily use to prevent headache.

Who gets analgesic rebound headache?
Unfortunately, anyone at any age or either gender who takes enough headache medication frequently enough is at risk. However, the typical patient with rebound headache is a woman in her 30s or 40s, whose headache history began in her teens, with occasional migraine headache. By her twenties, migraine attacks occurred more frequently and -- for fear of having a disabling headache -- she began to take nonprescription or prescription medication even for her mild headaches. After a while, she finds herself taking pain relievers more than 4 days each week and may take 4 to 12 tablets per day.

How does the headache feel?
A rebound headache is typically different in character from the initial chronic headache. Patients usually describe a mild-to-moderate, dull, non-throbbing, steady pain often felt in both sides of the forehead, top or back of the head (though rebound may cause a generalized or very focal headache). The headache tends to last from 6 to 24 hours. Most patients do not have migraine symptoms such as sensitivity to light and sound, nausea, or intensification of pain with mild exertion. In some cases, however, the headache may proceed to trigger a severe migraine episode. Indeed, rebound headache tends to progress, and, over time, the daily headaches become more migraine-like.

Some patients suffer feelings of depression and irritability, sleep disturbance, trouble concentrating, or other neurological and/or psychological symptoms.

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