Medication Overuse Headaches

Posted by Ryan Garver on May 3, 2017

Also known as rebound headaches, medication overuse headaches occur in individuals who deal with migraines or tension headaches where medication is used to manage the headaches. These headaches are marked by a transition from more episodic pain to chronic pain. The pain is usually described as occurring on both sides of the head and having a similar feel to a tension headache that occurs every day for at least part of the day. This pain can occur along side other migraines.

Causes

While the exact cause of overuse headaches are not fully understood, it is known that use of pain medication – including triptans, most over the counter analgesics, opioids, and even caffeine – can cause their onset when used frequently to treat headaches. The dosages necessary to trigger this condition can vary from person to person.

Do I Have One?

The International Headache Society’s standard for determining if a patient is suffering from a medication overuse headache is outlined in the International Classification of Headache Disorders §8.2. It describes three criteria:

  1. a headache occurring for more than 15 days per month in a person who was already suffering from some other headache disorder;
  2. the patient makes consistent excessive use of one or more medications for the treatment of headaches lasting for more than 3 months; or,
  3. the headache doesn’t fit with any other headache classifications.

As you can see this is a little hand wavy and if you are concerned that you may be suffering from overuse headaches you should consult an doctor, preferably a neurologist specializing in headaches. It is estimated that about half of all individuals suffering from headaches for more than 15 days per month for 3 months or longer are in fact suffering from an overuse headache.

Prevention

The general rule to prevent overuse headaches is to limit the frequency of use of pain killers in the treatment of headaches. This includes OTC drugs like acetaminophen (Tylenol), ibuprofen (Advil), naproxen (Aleve), and Excedrin. It also covers prescription abortive medications.

Clearly this is a non-trivial request, but it also illustrates why finding the right treatment and possible triggers for your pain can help reduce your risk. Preventative medications to reduce frequency and severity of headaches can reduce the amount of medication required to manage the pain. Moreover, finding the most effective abortive medication can help reduce the number of doses required to stop a developing or developed headache.

According to the IHS the benchmarks for overuse headaches can depend on the drug in question. Triptans, for example, are set as 10 or more doses per month for 3 months or longer. Most over the counter pain killers are set at one or more doses for 15 days per month for more than 3 months.

Treatment

To stop a medication overuse headache you need to stop the medication being overused. The drugs in question can dictate exactly how the drugs are removed; all at once, or gradually tapered. Some patients show a response to this treatment similar those being treated for addiction and in extreme cases will require hospitalization.

Once the drugs are rolled back most patients’ symptoms improve in about two months. The effectiveness of preventative drugs is also shown improve once the treatment is completed. It should be noted that this type of headache has a high rate of recurrence, some report as high as 45%. If you have been diagnosed with overuse headaches in the past it is recommended that you be extra vigilant about your use of medication for ongoing head pain management.