Introduction to Rebound Headache Rebound headache is one of the most common causes of daily headache. In a person who previously has only a couple of headaches per month, a transition to daily headache that occurs over a course of days or weeks often is the result of "withdrawal" from pain medication. Of course, there can be other causes of daily headache such as tumor, head injury, or aneurysm. When we have eliminated these from our differential, we must consider whether the pain medications that you are taking to treat your headaches may actually be the cause of your headaches. How Does it Start? Most of us have met people who must have their morning caffeine fix or they will be crabby or get a headache. They didn't start off this way. Caffeine is actually a potent headache relieving medication. They probably could drink a caffeinated beverage once or twice a week without a problem. In fact, they may have found that it relieved a headache or migraine. But it you ingest caffeine more than a few times a week, you may find that you get headaches when you stop drinking that daily caffeinated beverage. For instance, if I drink a cup of coffee each morning for just over one week and then stop, I will develop a mild frontal headache that can persist for almost two days before it is completely gone. Any Medication You Take to Treat a Headache Can Cause Rebound All headache medications, such as Tylenol, Motrin, Excedrin, Fironal, Imitrex, and Percocet (just to name a few), that are used to treat headache pain can, if used more than a couple times per week, act in the same way as caffeine to produce a withdrawal headache. You think that you are treating a headache with Tylenol or Motrin, but what you are actually treating is the withdrawal headache caused by the last dose of pain medication you took yesterday or the day prior. The pain medication will help with the headache. Just like a cup of coffee will relieve the caffeine withdrawal headache. Just as someone progresses over weeks and months from one cup of coffee every other day to five cups per day, you'll slowly increase your intake of pain medications. You'll find that the headache medications are less effective and have to be taken more often in order to keep the headaches down to a bearable level. You may find that the old medications don't work. You may have to frequently switch to using new medications that may work for a few days or weeks, but inevitably they become less effective as well. This pattern can continue for weeks, months, or years. I have seen people whose lives are nearly ruined from daily headaches. What Can You Do to Stop the Headaches? Rebound headache is a good diagnosis to have. Don’t shy away from it. Studies suggest that if this is the cause of your headaches, then you have an 85% chance of returning to just a few headaches per month. However, in order to succeed, you must have correct expectations. I’m not sure how it got to be “common knowledge” that these rebound headaches will stop in a week after you quit using pain medications. When I reviewed the studies, it appears that a few people get better in a week, about 30% are better in a month, 60% in 3 months, and over 80% in 9 months. In my experience, about 50% of people are better in 6 weeks. On the other hand, if do have rebound headaches and you don’t stop taking the acute headache medications, there is a good chance that you’ll only get minor benefit from any of my fancy prescription medications. It May Be Dangerous to Suddenly Stop Some Medications Before stopping your medications, a warning must be given. If you are taking certain medications that contain narcotics, barbiturates, or benzodiazepines, you will have to be weaned from these medications by a physician in order to avoid potential dangerous withdrawal side effects. Please have me review your medication list prior to stopping your pain pills. Remember This When Starting Any Treatment Plan Most diagnoses made by a physician are merely the best guess possible for the information we have at hand. If you develop changes in symptoms that go beyond what we discussed in our office visit, you must let me know. Most mistakes in diagnosis are really a mistake in follow-up. If you present me with information that helps me to consider a different diagnosis, we can prevent most of the common and usually unavoidable errors of wrong diagnosis. We will keep you safe by staying in frequent contact. Good follow-up is my greatest tool for combating disease, illness, and preventing injury as a result of making the wrong diagnosis. How I Approach the Treatment of Rebound Headache First, during your office visit, we will discuss whether you can stop taking your daily headache medications or whether you need to be weaned off them to avoid dangerous side effects. Most likely, if you are only taking simple analgesics, such as Tylenol, Motrin, Excedrin, BC powder, or Naproxen, for example, we can just stop them whenever you are ready. However, we should go over your medication list in detail to make sure you are not taking a medication that will cause dangerous withdrawal side effects. You should expect a bumpy ride for the first few weeks. We will not be using traditional pain medications to treat your headaches. And you will get headaches; that is how this rebound process works. The pain of the headache encourages you to take a pain medication and continue the cycle. When we stop the pain medications, the headaches will increase vigorously in response. However, if you can avoid using your traditional pain medications, you will see a slow reduction in the number of headaches over the next several weeks. We may allow the use of one pain medication per week as a "rescue" or we may advise against it, depending on your personal situation. What Can I Take to Get Me through the Detox Period? We may try to use medications that take the edge off of headache-related nausea or help with sleep. I will sometimes prescribe Phenegran, Compazine, or Reglan. These will only occasionally help with the pain of a headache. They may, however, help with nausea. Unfortunately there are not many medication strategies that are successful in reducing headaches during the withdrawal period. I've used steroids for a week or two, but haven't found them helpful. The best strategy is to start a preventative headache medication and work on lifestyle changes to reduce your triggers for headaches. Preventative Medications I may start you on a daily preventative medication such as Riboflavin, CoEnzyme Q10, Pamelor, Elavil, Topamax, or Propanolol. These medications, if taken for one to three months, may slowly reduce the total number of headaches you have per month. I tell people to expect to wait one to three months before seeing significant effects. These effects can be as subtle as reducing the total number of headaches you have per month by one third. Of course, other people can have more dramatic responses. I just don't want to mislead people with overly high expectations. The main reason why most people stop these medications prematurely is that they expect these medications to be fully effective in the first couple of days or weeks. Additionally, preventative medications do not treat the headache you have today. If you take them daily, they will help to prevent future headaches. However, doubling up on your preventive medication for an acute headache does nothing more than cause an increase in side effects, which could be potentially dangerous. Lastly, if you do not stop overusing your pain medications and remain in rebound headache, it is unlikely these preventive medications will be as successful as you wish them to be. Continue to How to Get out of Rebound Headache Return to Headaches

Introduction to Rebound Headache

Rebound headache is one of the most common causes of daily headache. In a person who previously has only a couple of headaches per month, a transition to daily headache that occurs over a course of days or weeks often is the result of "withdrawal" from pain medication. Of course, there can be other causes of daily headache such as tumor, head injury, or aneurysm. When we have eliminated these from our differential, we must consider whether the pain medications that you are taking to treat your headaches may actually be the cause of your headaches.

How Does it Start?

Most of us have met people who must have their morning caffeine fix or they will be crabby or get a headache. They didn't start off this way. Caffeine is actually a potent headache relieving medication. They probably could drink a caffeinated beverage once or twice a week without a problem. In fact, they may have found that it relieved a headache or migraine. But it you ingest caffeine more than a few times a week, you may find that you get headaches when you stop drinking that daily caffeinated beverage. For instance, if I drink a cup of coffee each morning for just over one week and then stop, I will develop a mild frontal headache that can persist for almost two days before it is completely gone.

Any Medication You Take to Treat a Headache Can Cause Rebound

All headache medications, such as Tylenol, Motrin, Excedrin, Fironal, Imitrex, and Percocet (just to name a few), that are used to treat headache pain can, if used more than a couple times per week, act in the same way as caffeine to produce a withdrawal headache. You think that you are treating a headache with Tylenol or Motrin, but what you are actually treating is the withdrawal headache caused by the last dose of pain medication you took yesterday or the day prior. The pain medication will help with the headache. Just like a cup of coffee will relieve the caffeine withdrawal headache. Just as someone progresses over weeks and months from one cup of coffee every other day to five cups per day, you'll slowly increase your intake of pain medications. You'll find that the headache medications are less effective and have to be taken more often in order to keep the headaches down to a bearable level. You may find that the old medications don't work. You may have to frequently switch to using new medications that may work for a few days or weeks, but inevitably they become less effective as well. This pattern can continue for weeks, months, or years. I have seen people whose lives are nearly ruined from daily headaches.

What Can You Do to Stop the Headaches?

Rebound headache is a good diagnosis to have. Don’t shy away from it. Studies suggest that if this is the cause of your headaches, then you have an 85% chance of returning to just a few headaches per month. However, in order to succeed, you must have correct expectations. I’m not sure how it got to be “common knowledge” that these rebound headaches will stop in a week after you quit using pain medications. When I reviewed the studies, it appears that a few people get better in a week, about 30% are better in a month, 60% in 3 months, and over 80% in 9 months. In my experience, about 50% of people are better in 6 weeks.

On the other hand, if do have rebound headaches and you don’t stop taking the acute headache medications, there is a good chance that you’ll only get minor benefit from any of my fancy prescription medications.

It May Be Dangerous to Suddenly Stop Some Medications

Before stopping your medications, a warning must be given. If you are taking certain medications that contain narcotics, barbiturates, or benzodiazepines, you will have to be weaned from these medications by a physician in order to avoid potential dangerous withdrawal side effects. Please have me review your medication list prior to stopping your pain pills.

Remember This When Starting Any Treatment Plan

Most diagnoses made by a physician are merely the best guess possible for the information we have at hand. If you develop changes in symptoms that go beyond what we discussed in our office visit, you must let me know. Most mistakes in diagnosis are really a mistake in follow-up. If you present me with information that helps me to consider a different diagnosis, we can prevent most of the common and usually unavoidable errors of wrong diagnosis. We will keep you safe by staying in frequent contact. Good follow-up is my greatest tool for combating disease, illness, and preventing injury as a result of making the wrong diagnosis.

How I Approach the Treatment of Rebound Headache

First, during your office visit, we will discuss whether you can stop taking your daily headache medications or whether you need to be weaned off them to avoid dangerous side effects. Most likely, if you are only taking simple analgesics, such as Tylenol, Motrin, Excedrin, BC powder, or Naproxen, for example, we can just stop them whenever you are ready. However, we should go over your medication list in detail to make sure you are not taking a medication that will cause dangerous withdrawal side effects.

You should expect a bumpy ride for the first few weeks. We will not be using traditional pain medications to treat your headaches. And you will get headaches; that is how this rebound process works. The pain of the headache encourages you to take a pain medication and continue the cycle. When we stop the pain medications, the headaches will increase vigorously in response. However, if you can avoid using your traditional pain medications, you will see a slow reduction in the number of headaches over the next several weeks. We may allow the use of one pain medication per week as a "rescue" or we may advise against it, depending on your personal situation.

What Can I Take to Get Me through the Detox Period?

We may try to use medications that take the edge off of headache-related nausea or help with sleep. I will sometimes prescribe Phenegran, Compazine, or Reglan. These will only occasionally help with the pain of a headache. They may, however, help with nausea. Unfortunately there are not many medication strategies that are successful in reducing headaches during the withdrawal period. I've used steroids for a week or two, but haven't found them helpful. The best strategy is to start a preventative headache medication and work on lifestyle changes to reduce your triggers for headaches.

Preventative Medications

I may start you on a daily preventative medication such as Riboflavin, CoEnzyme Q10, Pamelor, Elavil, Topamax, or Propanolol. These medications, if taken for one to three months, may slowly reduce the total number of headaches you have per month. I tell people to expect to wait one to three months before seeing significant effects. These effects can be as subtle as reducing the total number of headaches you have per month by one third. Of course, other people can have more dramatic responses. I just don't want to mislead people with overly high expectations. The main reason why most people stop these medications prematurely is that they expect these medications to be fully effective in the first couple of days or weeks.

Additionally, preventative medications do not treat the headache you have today. If you take them daily, they will help to prevent future headaches. However, doubling up on your preventive medication for an acute headache does nothing more than cause an increase in side effects, which could be potentially dangerous.

Lastly, if you do not stop overusing your pain medications and remain in rebound headache, it is unlikely these preventive medications will be as successful as you wish them to be.

Continue to How to Get out of Rebound Headache

Return to Headaches