Rebound or Medication Overuse
Headaches
David S. Larsen, MD
Center for Headache Medicine
Chicago, Illinois
Chances are if you are reading this article in HeadWise™
that you probably suffer from a primary headache
disorder or have a loved one who does. And, if you are
a regular HeadWise™ reader, then you understand that
getting educated about headaches is the first important
step in getting better. A common mantra of successful
migraine treatment is treating the headache quickly
and aggressively. This is because triptans, a main stay of
migraine treatment, do not work as well when taken later
in a headache episode. And, as the migraine headache
progresses, absorption of oral medications slows due to an
effect of a migraine on the stomach.
1. If the drug is: an ergotamine derivative, such as
dihydroergotamine (DHE), administered as injection
or nasal spray (Migranal); triptans such as sumatriptan (Imitrex); opioids (Norco, Vicodin, Lortabs, etc);
or, combination analgesic with caffeine–(Excedrin) or,
with butalbital–(Fioricet, Fiorinal). Overuse is greater
than 10 days/month for at least 3 months.
2. If the drug is a simple analgesic (acetaminophen,
naproxen, or ibuprofen) or any combination of ergotamine, triptans, analgesics, or opioids. Overuse is
greather than 15 days/month for at least 3 months.
Thus, the determining point is the number of medication treatment days experienced per month, for at least
3 months, especially if it is the same medication. This
pattern of medication overuse can make you worse – not
better. If you are following this pattern, you have probably developed a second type of headache, either rebound
or medication overuse-headache (MOH). Also, many
headache specialists believe this second headache type can
impact the daily preventive medications that have been
prescribed, and decrease their efficacy.
When is Taking Something for your
Headache not a Good Idea?
In spite of the above advice, some headache sufferers
can actually make their headaches ݽ