When the occasional headache strikes, most of us head for the
medicine cabinet or local pharmacy and take an over-the-counter analgesic, such
as acetaminophen, ibuprofen, aspirin, or pain-relieving medications containing
caffeine.
While over-the-counter analgesics are helpful in improving
headache pain, they must be taken with caution because they could actually make
your headaches worse if they aren’t taken correctly. The overuse or misuse of
analgesic medications — exceeding labeling instructions (such as taking the
medications three or more days per week) or not following your physician's
advice — can cause you to "rebound" into another headache. When the pain
medication wears off, you may experience a withdrawal reaction, prompting you to
take more medication, which only leads to another headache and the desire to
take more medication. And so the cycle continues until you start to suffer from
chronic daily headaches with more severe headache pain and more frequent
headaches.
Analgesic overuse appears to interfere with the brain centers
that regulate the flow of pain messages to the nervous system, worsening
headache pain.
This rebound syndrome is especially dangerous if your medication
contains caffeine, which is often included in many medications to speed up the
reaction of the other ingredients. While it can be beneficial, caffeine in
medications, combined with consuming caffeine (coffee, tea, soft drinks, or
chocolate) from other sources, makes you more vulnerable to a rebound headache.
In addition to the rebound headache, overuse of analgesics can
lead to addiction, more intense pain when the medication wears off, and possible
serious side effects.
Who is affected by analgesic-induced chronic daily headaches?
Any patient with a history of tension-type headaches, migraines,
or transformed migraines can be affected by rebound headaches if he or she
overuses certain medications. Some patients -- although they are few in number
-- can quickly develop rebound headaches by overusing analgesics, even without
having knowingly been a headache sufferer.
What analgesics are responsible for causing rebound headaches?
Many commonly used immediate relief medications, when taken in
large enough amounts, have been found responsible for inducing rebound
headaches.
Studies are being done indicating that medications once thought
of as "safe" are the likeliest culprits. Among these medications are aspirin,
sinus relief medications, acetaminophen, nonsteroidal anti-inflammatory
medications (NSAIDs), sedatives for sleep, codeine and prescription narcotics,
and over-the-counter combination headache remedies containing caffeine (such as
Anacin, Excedrin, Bayer Select, and others).
Other medications commonly associated with rebound headaches are
ergotamine preparations (Cafergot, Migergot, Ergomar, Bellergal-S,
Bel-Phen-Ergot S, Phenerbel-S, Ercaf, Wigraine and Cafatine PB), butalbital
combination analgesics (Goody’s Headache Powder, Supac, Excedrin) and opiates
(codeine). The triptans--which are migraine- specific medications and include
Imitrex, Zomig, Maxalt, Relpax, Axert, Frova, Amerge, and Treximet--taken more
than 2 times per week can also cause rebound.
While small amounts of these medications per week may be safe
(and effective), at some point, the continued medication use leads to the
development of low-grade headaches that just will not go away.
Taking larger or more frequent doses of the offending immediate
relief medication is not recommended. This not only exposes the person to a
higher level of the medication's harmful ingredients, but makes the headache
worse and continue indefinitely.
What is the treatment of analgesic-induced rebound headaches?
Rebound headaches are a progressive syndrome, meaning they will
continue to get worse until you receive the proper treatment.
It is important to recognize what is happening and seek medical
attention from a headache specialist.
Usually, discontinuing the medication or gradually tapering the
medication dose will lead to more easily controlled headaches with the use of
carefully administered abortive or preventive headache medications. You will
probably be asked to record your headache symptoms, noting the frequency and
duration of headaches.
Some patients may need to be "detoxified" under more carefully
monitored medical conditions. Patients taking large doses of sedative hypnotics,
sedative-containing combination headache pills, or narcotics such as codeine or
oxycodone may need to be admitted to the hospital so they can be detoxified and
recover under supervision, or be treated in an outpatient infusion room.
Unfortunately, for many chronic daily headache sufferers,
detoxification for the first several weeks leads to increasing headaches.
Supervision and treatment by a headache specialist are therefore very important.
Eventually, the headaches disappear and resume their previous
intermittent nature. Patients then find that prescribed preventive medications
are more effective.
How can rebound headaches be prevented?
Always follow the labeling instructions of your medications and
the advice of your physician.
Use pain-relieving medications on a limited basis, only when
necessary. Take the smallest dose needed to relieve your pain. Do not use
headache relief medications more than once or twice a week, unless instructed
otherwise by your physician.
Before taking any over-the-counter medication, including common
analgesics and antihistamines, ask your doctor if the medication has any
potential for interacting with your current prescription medications.
Avoid caffeine-containing products while taking a pain-relieving
medication, especially medication that already contains caffeine.
© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.
Can't find the health information you’re looking for?
Ask a Health Educator, Live!
Know someone who could use this information?...send them this link.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/27/2009...#6170
