Medication Overuse Headaches
Overview
Medication overuse headaches, also referred to as rebound headaches, are brought on by using medications for headaches for an extended period of time, causing more headaches. Headaches that occur occasionally can be relieved by pain medications. However, if you take them more than a few times each week, they could cause severe headaches when the medication wear off.
While individuals with headache disorders like migraines often experience headaches as a side effect of pain relief medication, this condition doesn’t seem to occur in those without a history of such disorders. Regular use of pain relievers for conditions like arthritis hasn’t been demonstrated to lead to medication overuse headaches in individuals who have never experienced headache disorders.
Medication overuse headaches typically subside upon discontinuation of pain medication usage. While ceasing medication can be difficult initially, your healthcare provider can assist you in developing strategies to overcome medication overuse headaches in the long term.
Symptoms
The signs and symptoms of medication overuse headaches may differ. The type of headache being treated and the medication used may have an effect on them.
Medication overuse headaches commonly signify:
- Pain.
- Headaches improve but the pain returns when the medicine wears off.
- Nausea.
- Difficulty to concentrate.
- Having problem remembering.
- Restlessness and irritability.
- Fatigue.
- Depression, anxiety or panic.
While occasional headaches are prevalent, it’s crucial to treat them seriously. Certain types of headaches can pose life-threatening risks.
Seek immediate medical attention if you have the following:
- Sudden and severe headache.
- Headache accompanied by a rash, fever, stiff neck, dizziness, seizures, double vision, weakness, numbness, shortness of breath, or difficulty speaking.
- Present when you’re standing but disappears when you’re lying down.
- Does not improve with rest or pain medication.
- Occurs after a head injury.
- Is a new type of headache that persists, particularly in individuals over 50 years old.
- Is accompanied by shortness of breath.
Seek advice from your healthcare provider if:
- Changes headache pattern.
- Chronic headache, particularly in those over 50.
- Having two or more headaches a week.
- Taking pain reliever for headaches for more than two times a week.
- To relieve your headaches, you require more nonprescription pain medication than what is suggested.
Causes
The exact cause of medication overuse headaches is still unknown to experts. Depending on the medication, there are different chances of getting them. However, the majority of headache medications have the potential to cause medication overuse headaches, such as:
- Common pain relievers: Aspirin and acetaminophen, two common painkillers, may be a cause in medication overuse headaches. This is particularly true if you exceed the daily amounts that are advised. There is low risk that other analgesics such naproxen sodium and ibuprofen can cause medication overuse headaches.
- Combination of pain relievers: Bought from a store pain medicines that contain acetaminophen, aspirin, and caffeine are frequently the cause of problems.
This also includes prescription combination medications that contain the sedative butalbital. Medication overuse headaches are particularly common with medications containing butalbital. It is advisable not to use them as a treatment for headache. - Opioids: There is a significant chance that painkillers made from opium or from synthetic opium substances will result in medication overuse headaches. Codeine and acetaminophen combinations are among them.
- Migraine medicines: Medication overuse headaches have been related to a number of migraine medications. These include specific headache medications known as ergots, including ergotamine, and triptans. There is a moderate chance that these medications will result in medication overuse headaches. It seems that the ergot dihydroergotamine has a decreased potential to cause medication overuse headaches.
Medication overuse headaches don’t seem to be brought on by a more recent class of migraine medications called gepants. Umbrogepant and rimegepant are examples of gepants.
Caffeine use on a daily basis may potentially worsen medication overuse headaches. Coffee, soda, painkillers, and other goods can contain caffeine. Make sure you’re not consuming more caffeine than you think by reading product labels.
Risk factors
The following are risk factors of medication overuse headaches:
- Age: Individuals who are between the ages of 30 – 50 are at risk in developing the condition.
- Gender: Female are more common in developing medication overuse headache because migraine usually effect female rather than men.
- History of chronic headaches: You are at risk if you have a history of chronic headaches, particularly migraines.
- Consistent usage of headache medications: If you take combination painkillers, opioids, ergotamine, or triptans ten or more days each month, your risk will increase. Additionally, using mild painkillers more than 15 days per month increases risk. This is particularly valid if you use these medications for a duration of three months or more.
- Substance use disorders: You are at risk if you have a history of alcoholism or another substance abuse problem.
- Mental health disorder: If a person has mental health issues, particularly depression, anxiety, panic disorder, or post-traumatic stress disorder, their risk will increase.
Diagnosis
The medication overuse headaches can be diagnosed by a healthcare provider using the criteria of the International Classification of Headache Disorders. The following criteria includes:
- Frequent headaches occurring at least 15 days per month, linked to a pre-existing headache disorder.
- Taking medicine on a regular basis for at least three months to relieve the headaches.
- There isn’t a clearer diagnosis or disease to account for the headaches.
Treatment
The medication overuse headache is treatable. You will need to limit your pain medication in order to stop the cycle of medication overuse headaches. The healthcare provider could advise discontinuing the medication immediately or lowering the dosage gradually.
- Stop the cycle: It’s common for headaches to go worse before getting better when you stop taking medication. Certain medications might cause you to become dependent on them, which can lead to headaches from overusing them. Patient may expect to experience withdrawal symptoms. Typically lasting from 2 to 10 days, these symptoms can endure for several weeks in some cases.
Treatments for headache pain and medication withdrawal symptoms may be prescribed by your healthcare provider. They refer to this as transitional or bridge treatment. Nonsteroidal anti-inflammatory medications, corticosteroids, and nerve blocks are possible treatment options. Additionally, your healthcare provider may advise getting ergot dihydroergotamine intravenously. Withdrawal headaches typically show improvement within a week or less. - Hospitalization: It’s sometimes preferable to quit using painkillers in a controlled setting. A brief hospitalization might be advised if you:
- Have concurrent conditions like depression or anxiety.
- Are prescribed high dosages of medications containing opiates or the sedative butalbital.
- Are engaging in substance use, such as tranquilizers, opioids, or barbiturates.
- Preventive medications: You may be able to stop the cycle from medication overuse headaches. To prevent relapsing and to discover a safer method of managing your headaches, work with your healthcare provider. They could recommend a daily preventative medication during or after withdrawal such as
- An anticonvulsant like topiramate.
- A tricyclic antidepressant such as amitriptyline or nortriptyline.
- A beta blocker like propranolol.
- A calcium channel blocker such as verapamil.
Your healthcare provider may recommend an injection of a CGRP monoclonal antibody, such as eptinezumab, galcanezumab, fremanezumab, or erenumab, if you have a history of migraines. Monthly injections are available for fremanezumab, galcanezumab, and erenumab. An IV injection of eptinezumab is administered every three months.
Pain management is possible with these medications without running the risk of medication overuse headaches. If you have headaches again, you might be able to take a medication designed to treat pain. Make sure you take them precisely as directed.
- Injections: OnabotulinumtoxinA (Botox) injections may help you have fewer headaches every month. They could help lessen the intensity of headaches.
- Cognitive behavioral therapy (CBT): This type of therapy provides headache coping mechanisms. Along with working on healthy lifestyle choices, CBT also involves headache diaries.
- Alternative medicine: Alternative or complementary treatments relieve headache discomfort for a large number of people. Not every one of these methods has been researched as a headache treatment. Additional research is required for certain medicines. With a healthcare provider, go over the advantages and disadvantages of alternative treatments. This may includes:
- Acupuncture: The central nervous system’s inherent painkillers and other chemicals are released with the use of small needles in this traditional procedure. Headaches may be lessened with this treatment.
- Biofeedback: You can learn to regulate certain physical responses which help in pain reduction through biofeedback. You are connected to monitoring equipment during biofeedback. They provide you with input on physical parameters including blood pressure, heart rate, and muscular tension. After that, you discover how to ease tense muscles, lower your respiration and pulse rate, and calm down. By calming you down, this may make it easier for you to handle discomfort.
- Supplements: Certain dietary supplements appear to help in the treatment or prevention of specific headache types. However, these claims are not well supported by research. These consist of coenzyme Q10, magnesium, feverfew, and riboflavin, or vitamin B2. Consult your healthcare provider if you’re thinking about using supplements. Certain supplements may cause problems if you also use other medications. Or they might have additional negative consequences.
