Rebound Headaches: When the Solution is the Problem.
Too much of a good thing can be a real "headache" for migraine sufferers. Analgesics (pain killers) that are designed to relieve pain - when overused, can actually cause headaches. Go figure.
This was a hard “reality check” that I had with a recent new patient during their examination, I really think they just thought in that moment I’m a chiropractor that “doesn’t believe in meds.” Without going on a tangent about that, I reassured this patient that in fact, part of their complaint was made worse by their excessive Motrin (Ibuprofen) use. Considering this patient was never made aware of that, I thought this would be a great teaching moment for those of you who are interested and or struggle with headaches.
“Rebound headaches” aka “MOH” (medication overuse headaches) can result when people become dependent on analgesics, particularly with (but limited to) over-the-counter drugs (OTCs). I think part of the reason why I see this in my field more-so with OTC meds is because these drugs can be purchased without a prescription and many people assume they can be used casually. In my 11 years of practice so far, this often leads to chronic over-usage.
To be diagnosed with medication overuse headaches, a person must experience headaches on more than 15 days per month for at least three months while taking pain relieving and/or anti-migraine drugs. (Side bar): Let me just say, if you’re having headaches that often PLEASE don’t think that it is normal, it’s not. You should really be seen by a good chiropractor among other health providers. Ok to now that we got that out of the way….
A variety of medications can lead to rebound headaches. For example, people with migraines who take over-the-counter pain-relieving medications such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve) more than 15 days per month are at risk for medication overuse headache. So are people who take combination medications such as Excedrin, which contains caffeine, aspirin, and acetaminophen; people who take combination medications that contain the barbiturate butalbital; and those who take triptans, including sumatriptan (Imitrex), ergots, or opioids, if they take these medications more than 10 days per month. In fact, butalbital-containing medications and opioids have been shown to increase the risk of a person’s migraine progressing from episodic (occurring zero to 14 days per month) to chronic (occurring 15 or more days per month). 1
Interestingly, the same pain-relieving medications taken for other conditions such as back pain, neck pain, or arthritis usually do not trigger medication overuse headache in people without a pre-existing primary headache disorder. I definitely don’t encourage regular use of OTC meds to manage pain for a number of other reasons: ulcers, bleeding ulcers, liver damage etc. (that’s a different article). It’s not because “I don’t believe in taking medicine” it’s well documented in scientific literature. 2
In summary then, it is critical to point out that over-usage of any acute or symptomatic medication, be it a prescription or non-prescription drug, can lead to the phenomenon of rebound headache/MOH. A very good rule of thumb to remember is that these medicines should be restricted in their use. If you are using these medications more than that, you need to inform your doctor and develop an alternative strategy. Remember that you do not want "the cure" to become part of "the disease."
Lastly, never forget that sometimes our symptoms are as a result of a challenge elsewhere in the body. Do your due diligence in learning from and about your body and get to the cause of the problem versus only making yourself “numb” to it. Knowledge is power and real health never comes from a bottle of any kind.