Rebound headaches (medication-overuse headaches) are caused by frequent use of headache medication. Pain relievers offer relief for occasional headaches, but if you take them more than a couple of days a week, you may trigger rebound headaches.
How frequently rebound headaches occur depends on the type and dose of overused drug and the frequency of headaches. For example, for opiates, rebound headaches may occur after eight days of use a month, whereas for barbiturates it takes only about five days of use a month. This happens because your body adapts to the medication.
To stop rebound headaches, reduce or stop taking the pain medication. It's tough in the short term, but your doctor can help you beat rebound headaches for long-term relief.
Rebound headaches tend to:
Other signs and symptoms may include:
When to see a doctor
Seek immediate medical care if your headache:
Consult your doctor if:
It's not clear why rebound headaches occur. However, scientists suspect that regular use of headache medications alters the way certain pain pathways and receptors work in the brain.
Rebound headaches can develop if you frequently use headache medication. Although the risk of developing medication-overuse headache varies depending on the medication, any acute headache medication has the potential to lead to rebound headaches, including:
Daily doses of caffeine — from your morning coffee, your afternoon soda, or any pain reliever or other product containing this mild stimulant — may fuel rebound headaches as well. Read product labels to make sure you're not wiring your system with more caffeine than you realize.
Risk factors for developing rebound headaches include:
People who don't have frequent headaches but use pain medications daily to treat other conditions such as arthritis typically don't have rebound headaches.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. You may then be referred to a doctor who specializes in nervous system disorders (neurologist).
It's good to arrive at your appointment well prepared. Here's some information to help you get ready for your appointment, and to help you know what to expect from your doctor.
What you can do
Preparing a list of questions can help you make the most of your time with your doctor. For rebound headaches, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions that occur to you.
What to expect from your doctor
What you can do in the meantime
A headache diary can be very helpful for your doctor. Try to keep track of when your headaches occur, their severity and duration, what you were doing when the headache began, and what your response to the headache was.
Tests and diagnosis
Your doctor will probably do a physical exam to check for signs of illness, infection or neurological problems. The diagnosis of rebound headache usually is based on a history of chronic headache and frequent use of medication. Testing usually isn't necessary.
Treatments and drugs
To break the cycle of rebound headaches, you'll need to restrict how much pain medication you use. Depending on what drug you've been taking, your doctor may recommend stopping the medication right away or gradually reducing the dose until you're taking the drug no more than twice a week, and possibly less if you're taking a medication that contains butalbital.
Breaking the cycle
Your doctor may prescribe various treatments to help alleviate headache pain and the side effects associated with drug withdrawal. Dihydroergotamine (D.H.E. 45), an injectable ergot, helps relieve rebound-headache pain during the withdrawal process. D.H.E. 45 also can be used later on for the treatment of migraines, because it doesn't have the same risk of rebound headaches as other medications do. However, doctors may use other treatments instead of D.H.E., such as brief courses of corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs).
These medications can help control your pain without risking another cycle of rebound headaches. If you're careful, you may be able to take a medication specifically meant for pain during future headache attacks. Be sure to take any medication exactly as prescribed.
Cognitive behavioral therapy (CBT)
It's important to continue to work with your doctor after you've successfully withdrawn from your headache medications, because some people relapse and begin the rebound-headache cycle again.
For many people, complementary or alternative therapies offer welcome relief from headache pain. It's important to be cautious, however. Not all complementary or alternative therapies have been studied as headache treatments, and others need further research.
If you'd like to try a complementary or alternative therapy, discuss the risks and benefits with your doctor.
Coping and support
Coping with rebound headaches can be especially difficult. The same medication you've relied on to bring you relief from your headache pain is now causing that pain. You may find it helpful or encouraging to talk to other people who've been through the same experience. Ask your doctor if there are any support groups in your area, or contact the National Headache Foundation at www.headaches.org or 888-643-5552.
The following tips can help you prevent rebound headaches:
Taking good care of yourself can help prevent most types of headaches.
Last Updated: 2011-12-09
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