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Medication overuse headaches

Medically reviewed by Drugs.com. Last updated on Feb 28, 2023.

Overview

Medication overuse headaches — also known as rebound headaches — are caused by the long-term use of medicines to treat headaches such as migraines. Pain relievers offer relief for occasional headaches. But if you take them more than a couple of days a week, they may trigger headaches.

If you have a headache disorder such as migraine, most medicines you take for pain relief can have this effect. However, this doesn't appear to be true for people who have never had a headache disorder. In people without a history of headaches, taking pain relievers regularly for another condition such as arthritis hasn't been shown to cause medication overuse headaches.

Medication overuse headaches usually go away when you stop taking pain medicine. This can be challenging in the short term. But your health care provider can help you find ways to beat medication overuse headaches for the long-term.

Symptoms

Symptoms of medication overuse headaches may vary. They can depend on the type of headache being treated and the medicine used. Medication overuse headaches tend to:

Other symptoms may include:

When to see a doctor

Occasional headaches are common. But it's important to take headaches seriously. Some types of headaches can be life-threatening.

Seek immediate medical care if your headache:

Consult your health care provider if:

Causes

Experts don't yet know exactly why medication overuse headaches occur. The risk of developing them varies depending on the medicine. But most headache medicines have the potential to lead to medication overuse headaches, including:

Daily doses of caffeine also may fuel medication overuse headaches. Caffeine may come from coffee, soda, pain relievers and other products. Read product labels to make sure you're not getting more caffeine than you realize.

Risk factors

Risk factors for developing medication overuse headaches include:

Prevention

To help prevent medication overuse headaches:

Taking care of yourself can help prevent most headaches.

Diagnosis

Your health care provider can usually diagnose medication overuse headaches based on your history of headaches and regular use of medicine. Testing usually isn't necessary.

Treatment

To break the cycle of medication overuse headaches, you'll need to restrict pain medicine. Your health care provider may recommend stopping the medicine right away or gradually reducing the dose.

Breaking the cycle

When you stop your medicine, expect headaches to get worse before they get better. You can develop a dependence on some medicines that result in medication overuse headaches. Withdrawal symptoms may include:

These symptoms generally last 2 to 10 days. But they can persist for several weeks.

Your health care provider may prescribe treatments to help with headache pain and the side effects of medicine withdrawal. This is known as bridge or transitional therapy. Treatments may include nonsteroidal anti-inflammatory drugs, corticosteroids or nerve blocks. Your provider also might recommend the ergot dihydroergotamine given through a vein.

There's debate over how much benefit bridge therapy may offer. There's also debate about whether one treatment works better than others. Withdrawal headaches tend to improve in less than a week.

Hospitalization

Sometimes it's best to be in a controlled environment when you stop taking pain medicine. A short hospital stay may be recommended if you:

Preventive medications

Preventive medicines may help you break the cycle of medication overuse headaches. Work with your health care provider to avoid relapsing and to find a safer way to manage your headaches. During or after withdrawal, your provider may prescribe a daily preventive medicine such as:

If you have a history of migraine, your health care provider might suggest an injection of a CGRP monoclonal antibody such as erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (Ajovy) or eptinezumab (Vyepti). Erenumab, galcanezumab and fremanezumab are monthly injections. Eptinezumab is given every three months with an IV infusion.

These medicines can help control your pain without risking medication overuse headaches. You may be able to take a medicine specifically meant for pain during future headaches. But be sure to take them exactly as prescribed.

Injections

Injections of onabotulinumtoxinA (Botox) may help reduce the number of headaches you have each month. They also may make headaches less severe.

Cognitive behavioral therapy (CBT)

This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary.

Alternative medicine

For many people, complementary or alternative therapies offer relief from headache pain. However, not all of these therapies have been studied as headache treatments. For some therapies, further research is needed. Discuss the risks and benefits of complementary therapy with your health care provider.

Possible therapies include:

Coping and support

You may find it helpful to talk to other people who've been through the same experience you're having. Ask your health care provider if there are support groups in your area. Or contact the National Headache Foundation at www.headaches.org or 888-643-5552.

Preparing for an appointment

You're likely to start by seeing your primary care provider. You may then be referred to a doctor who specializes in nervous system disorders, known as a neurologist.

Here's some information to help you get ready for your appointment.

What you can do

For medication overuse headaches, some questions to ask your health care provider include:

Don't hesitate to ask any other questions.

What to expect from your doctor

Your health care provider will ask questions about your headaches, such as when they started and what they feel like. The more your provider knows about your headaches and medicine use, the better care your provider can give you. Your provider may ask:

What you can do in the meantime

Until your appointment, take your medicine only as directed by your health care provider. And take care of yourself. Healthy lifestyle habits can help prevent headaches. They include getting enough sleep, eating plenty of fruits and vegetables, and getting regular exercise. Avoid any known headache triggers.

A headache diary can be very helpful for your health care provider. Keep track of when your headaches occurred, how severe they were and how long they lasted. Also write down what you were doing when the headache began and what your response to the headache was.

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