And certain classes of medication are both more likely to relieve pain and to lead to these types of headaches. They include opioid combinations such as acetaminophen and oxycodone Percocet , acetaminophen and hydrocodone Vicodin , or oxycodone OxyContin , as well as combination medication that contains butalbital, a barbiturate, aspirin or acetaminophen, and caffeine, such as Fiorinal, Fioricet, and Esgic.
Triptans such as sumatriptan Imitrex and zolmitriptan Zomig —and even analgesics such as acetaminophen and ibuprofen—can also cause medication-overuse headache. The first step is to find alternative treatment for acute attacks, says Dr. For example, if you're overusing opioids or barbiturates, your doctor may prescribe triptans or nonsteroidal anti-inflammatory drugs NSAIDs.
Patients must gradually taper off caffeine, barbiturates, and opioids to avoid abstinence syndrome: In addition to severe pain, abrupt withdrawal of opioids or barbiturates can cause irritability, sleeplessness, and sometimes seizures, says Dr.
Lipton, adding that patients overusing barbiturate or opioid analgesics may require medically supervised withdrawal and pain management with intravenous drugs in a hospital. Do these headaches go away after treatment? Yes, but patients remain at risk for relapse if they start taking too much medication again, says Dr. Ongoing treatment usually includes preventive medication or a change of preventive medication if previous ones weren't effective. During or after withdrawal, your doctor may prescribe any of the following daily preventive medications:.
These medications can help control your pain without risking medication overuse headaches. If you're careful, you may be able to take a medication specifically meant for pain during future headache attacks. Be sure to take medications exactly as prescribed. Injections of onabotulinumtoxinA Botox may help reduce the number of headaches experienced per month as well as headache severity.
During this talk therapy, you learn ways to cope with your headaches. In CBT , you also work on healthy lifestyle habits and keeping a headache diary. For many people, complementary or alternative therapies offer relief from headache pain. However, not all complementary or alternative therapies have been studied as headache treatments, and others need further research. Discuss the risks and benefits of complementary therapy with your doctor. You may find it helpful to talk to other people who've been through the same experience you're having.
Ask your doctor if there are support groups in your area, or contact the National Headache Foundation at www. You're likely to start by seeing your family doctor or a general practitioner. You may then be referred to a doctor who specializes in nervous system disorders neurologist. The doctor will ask questions about your headaches, such as when they started and what they feel like.
The more the doctor knows about your headaches and medication use, the better care he or she will be able to provide. Your doctor may ask:.
Until your appointment, take your medication only as directed by your doctor, and take care of yourself. Mays notes, adding that most MOH headaches are migrainous and some are tension-type. Mays says, acknowledging that headaches will generally worsen for a week or two after abrupt withdrawal, but then will continue to improve over the next several months.
Mays contends. The reward is feeling better faster. You can offer a 10 percent wean per week, but that just drags it out. Explaining how discontinuing medications will help MOH symptoms — sleep, anxiety, depression, sinus congestion — is very important, as is being honest and direct about the likely cause of their headaches.
Bridge therapy, using DHE, steroids, IV medications such as magnesium or valproate sodium, can be used for patients struggling to break the cycle or taking high doses of opioids, barbiturates or butalbital, she adds.
BT injections can be administered to several locations, depending on whether the headache is migrainous, cervicogenic or related to the temporomandibular joint TMJ , Dr. Cheng says. Blocking the occipital, temporal, supraorbital or temporal nerve may provide a similar benefit, Dr.
In some cases , a person may require hospitalization to undergo a medically supervised withdrawal, especially if underlying conditions may need treatment. According to the British Association for the Study of Headache BASH , a person may experience withdrawal headaches between 2—10 days after stopping the medication that caused the rebound headaches.
BASH also states that complete improvement can take up to 12 weeks. This discrepancy may be due to various reasons and risk factors. The less frequently a person uses painkillers to treat headaches as they occur, the less likely they are to develop rebound headaches. If a person needs to use headache-relieving medication, they should ensure that they follow the directions on the packets to prevent rebound headaches from occurring.
People should limit the use of headache medications to at most 10 times per month. Individuals should also talk with their doctor if they experience headaches more frequently, as they may be a good candidate for prophylaxis medication.
The best way for people to prevent rebound headaches is to treat the underlying chronic or persistent headaches with preventive medication. Additionally, overusing medications can lead to other issues, such as stomach ulcers, gastrointestinal bleeding, and kidney problems. Some OTC medications that can cause problems with long-term use include aspirin , acetaminophen , and ibuprofen. Excessive use of medication to treat headaches can cause rebound headaches. They can be more debilitating than the initial headache a person was trying to treat and cause long-term health issues.
Rebound headaches are difficult to successfully treat as a high percentage of people who receive treatment go on to relapse and therefore develop rebound headaches once more. Therefore, preventing rebound headaches in the first instance is essential.
People experiencing frequent headaches should talk with their doctor, who may prescribe preventive headache medications. These medications can help prevent individuals from developing rebound headaches through the overuse of pain medications.
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