Let’s Talk About Rebound Headaches

Tackling rebound headaches (also known as Medication Overuse Headaches or MOH) has been a massive part of getting my migraines under control.  Rebound headaches are intense, frequent, and don’t respond well to medication.

The Cleveland Clinic has a good explanation of rebound headaches and which medications cause MOH headaches:

What are rebound headaches and analgesic overuse?

When the occasional headache strikes, most of us take an over-the-counter (OTC) analgesic, such as acetaminophen, ibuprofen, aspirin, or a pain-relief medication containing caffeine. While OTC analgesics can help relieve headache pain they must be taken correctly — or they could actually make your headaches worse.

The overuse or misuse of analgesic drugs — exceeding labeling instructions (such as taking the medications three or more days per week) or not following your healthcare provider’s advice — can cause you to “rebound” into another headache.

When the pain reliever wears off, you may experience a withdrawal reaction, prompting you to take more medication. This only leads to another headache and the desire to take yet more medication. So the cycle continues until you start to suffer from chronic daily headaches, with more frequent headaches and more severe pain.

I think that we’re so used to trying to keep up with everyone around us that we overuse analgesics to get through the day.  I never wanted to be the person that couldn’t fully participate in events with family, friends, or work.  The reactions of others when I call out of work or school because I have yet another migraine really deterred me from taking care of myself.  I felt like the only people who believed were my parents and roommates.

In the first few days of living at college, I had to go home because I was in so much pain.  When I came back to school, I explained to my roommates that I had a migraine, which happens frequently.  My roommate responded, “Yeah, it was nerves.”  I’ll never dispute the fact that stress causes an uptick in migraines, but migraines are a neurological disorder.  Most chronic migraineurs manage their stress, what they eat, and all possible triggers and still have migraines.  A genetic, neurological disease affects people of all stress levels.

I was taking Excedrin Migraine anytime I felt a headache coming, which was twice a day, every day.  For as long as I can remember, I would wake up with a mild headache that turned into a painful migraine by 10am.  When I told my headache doctor about this, he said: “I hope you aren’t having rebound headaches.”  I knew about rebound headaches because my neurologist had me taper off Excedrin Migraine.  However, I never understood what I could do to PREVENT rebound headaches.  I researched rebound headaches so I could get out of rebound. 

The Ament Headache Center talks about treating rebound headaches:

Often, treating rebound headache can be done in the outpatient setting.  It may require several attempts, and a number of adjustments in the plan along the way – another reason to enlist the help of your physician.  However, in some cases, the safest, most compassionate, and most successful way to eliminate rebound headaches requires hospitalization.  Consult with your physician for the most appropriate option for you.

Since I had tapered Excedrin Migraine in the past and was given steroid taper, I decided the best way to get out of rebound was to go cold turkey with all analgesics.  Tackling rebound headaches is not easy, and some people require hospitalization.  I made through two days without Excedrin until the pain was so bad that I was in tears.  I broke down and took an Imitrex, which helped my pain but also felt like a failure.  I was able to get through next week without relying on medications.  I used the WellPatch patches and the Aculief wearable religiously that week.  After that, I vowed to do my best to prevent rebound headaches.

The most effective way to treat rebound headaches is to stop using analgesics all together.  Most doctors say that tapering analgesics or a steroid taper just prolongs the process.

I currently keep rebound headaches at bay by keeping a log of all the analgesics I take.  I write down how many times I take each pill in that month.  I can’t recommend Migraine Buddy enough, this app helps to track what medicine I take and when.  Migraine Buddy has also been invaluable at tracking my triggers, what’s is helpful, and where the pain is located.  Because of Migraine Buddy, I am much better prepared to describe my migraines to the doctor.

From my research, I learned that analgesics should be used less than ten times each month.  My neurologist advised that she recommends using analgesics no more than twice per week.  I think everyone is different, and each body is unique, so you might be able to handle more or less of what is recommended.

I keep this little table in my notes so I can easily track each medication:

Banishing Rebound Headaches
Medication Number of times used (less than 10)
Triptan ex: Imitrex #
Excedrin(Acetaminophen & Aspirin) #
Naproxen ex: Aleve #
Ibuprofen #