Medication Overuse Headache

Overview

Medication overuse headache, also known as rebound headache, is a type of headache that occurs due to the long-term use of medicines to treat headaches such as migraines. It is caused by excessive use of pain relievers, which can lead to a cycle of headaches and medication dependence. Regular use of headache medicines, including combination painkillers, opioids, ergotamines, and triptans, can increase the risk of developing medication overuse headaches. To avoid this condition, it is essential to use pain medication only when necessary and as directed by a healthcare provider.

Understanding the disease

Symptoms

Symptoms of medication overuse headaches may vary, but they typically occur every day or nearly every day, wake you in the early morning, and improve with pain medicine but then return as the medicine wears off. Other symptoms may include nausea, restlessness, trouble concentrating, memory problems, and irritability. If you experience sudden and severe headaches, have a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness, or trouble speaking, seek immediate medical care. If your headache follows a head injury, gets worse despite rest and pain medicine, is a new persistent headache, especially in someone older than 50, occurs with shortness of breath, or occurs when you're upright but goes away if you're lying flat, it's important to consult your healthcare provider.

Risk Factors

Risk factors for developing medication overuse headaches include a history of lifelong headaches, especially migraines, regular use of headache medicines, and daily doses of caffeine. Additionally, using combination painkillers, opioids, ergotamine, or triptans for 10 or more days a month increases the risk. Using simple painkillers more than 15 days a month also increases the risk, especially if used for three months or longer.

Development

Medication overuse headaches, also known as rebound headaches, develop as a result of the long-term use of medicines to treat headaches such as migraines. Pain relievers, including opioids and simple painkillers, can trigger headaches when taken more than a couple of days a week. Regular use of headache medicines, such as combination painkillers, opioids, ergotamine, triptans, and certain migraine medicines, increases the risk of developing medication overuse headaches. Daily doses of caffeine can also contribute to the development of these headaches.

Assessment and Diagnosis

Triage

You should see a doctor if medication overuse headache is suspected when:

1. The headache is sudden and severe.
2. The headache occurs with a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness, or trouble speaking.
3. The headache follows a head injury.
4. The headache gets worse despite rest and pain medicine.
5. The headache is a new type of headache that's persistent, especially in someone older than 50.
6. The headache occurs with shortness of breath.
7. The headache occurs when you're upright but goes away if you're lying flat. In addition, consult your healthcare provider if:
8. You usually have two or more headaches a week.
9. You take a pain reliever for your headaches more than twice a week.
10. You need more than the recommended dose of nonprescription pain medicines to relieve your headaches.
11. Your headache pattern changes. It's important to take headaches seriously and seek medical attention when necessary.

Diagnosis

A medication overuse headache is typically diagnosed based on the individual's history of headaches and regular use of pain medicine. Your healthcare provider can usually diagnose medication overuse headaches without the need for further testing. They may ask about the medications being used and the frequency of use to determine if medication overuse is the cause of the headaches. If other conditions are suspected, such as depression or anxiety, additional tests may be necessary. Withdrawal symptoms may occur when the medication is stopped, and these can include nervousness, restlessness, nausea, vomiting, insomnia, and constipation.

Management and Treatment

Treatment

Treatments for medication overuse headaches involve reducing or discontinuing the use of the medication that is causing the headaches. Here are some steps to help manage and overcome medication overuse headaches:

1. Consult a healthcare provider: Seek the advice of a healthcare professional to properly diagnose your condition and determine the most appropriate treatment plan.
2. Gradual tapering: Depending on the medication and the severity of the headaches, your healthcare provider may recommend gradually reducing the dosage or frequency of the medication to minimize withdrawal symptoms.
3. Non-pharmacological treatments: Over-the-counter pain relievers and other medications should be avoided during the tapering process. Instead, your healthcare provider may recommend non-pharmacological treatments such as stress management techniques, relaxation exercises, and biofeedback to help manage headache symptoms.
4. Pain management strategies: Your healthcare provider may suggest alternative pain management strategies for acute headaches, such as cold or warm compresses, rest in a dark room, or over-the-counter pain relievers like acetaminophen, ibuprofen, or naproxen.
5. Preventive medications: For some individuals, preventive medications may be prescribed to reduce the frequency or severity of headaches. These could include antidepressants, anticonvulsants, or blood pressure medications, depending on your specific situation. It's important to work closely with your healthcare provider to develop a personalized treatment plan and to adhere to the recommendations provided. Remember that recovery from medication overuse headaches may take time, patience, and persistence.

Preparing for medical consultation

To prepare for an appointment regarding medication overuse headache, you should:

1. Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as adjusting your current medication or avoiding certain pain medications.
2. Write down any symptoms you're experiencing, including any that may seem unrelated to your headaches.
3. Note any key personal information, such as any major stresses or recent life changes that could be contributing to your headaches.
4. Make a list of all medications, vitamins, or supplements you are currently taking, including any pain medications or headache-specific medications.
5. Consider bringing a family member or friend along for support, as they may help remember important details or provide additional perspective. Before your appointment, research medication overuse headache to better understand the condition, its causes, and potential treatment options. This will help you have a more informed conversation with your healthcare provider.