Overuse of Medication can Cause Rebound Headaches

Over-the-Counter Medicines can Trigger Symptoms for Those with Chronic Headaches

Paula Mendes, MD

Chronic headache sufferers know what it’s like once an over-the-counter medication seems to work, it soon becomes an old standby, the first line of defense when the next headache threatens. It’s an understandable response—we all tend to go with what works. The problem is repetitive use of many common over-the-counter medications can actually bring on headaches, making a difficult situation even harder to bear. This phenomenon is called rebound, and it is one of the most common problems I observe in people who suffer from chronic headaches.

The Vicious Cycle of Rebound Headache

If you’ve been taking the same headache medication for some time, you may have observed that its effectiveness has diminished. You might be taking more of the drug, or more often. What’s more, even preventative medications prescribed by your doctor are failing to help. With all the drugs you’re taking, why are you having more headaches than ever? Why aren’t your old standbys working anymore?

A good rule of thumb to remember: If you have to take a particular pain medication every day to get rid of a headache, it’s not working.

This vicious cycle of increasing self-medication and escalating symptoms is one of the hallmarks of rebound headaches. The problem often builds gradually, as patients begin to take higher doses of over-the-counter drugs, sometimes without even realizing they’re doing so. Taking a cue from what we know about opiates, one might think the body is simply building a tolerance to the medication, requiring a higher and higher dose to achieve the same level of relief. This isn’t quite right, though; a different process is at work. With rebound headaches, the medication doesn’t just fail to diminish symptoms; it actually brings them on, leaving us worse off than before. While rebound can occur with a range of medications, it is most common with over-the-counter medicines, which are readily accessible and thus easier to overuse. Some may contain secondary ingredients, like caffeine, that further complicate the situation.

Headache medications are generally of two types. Preventative drugs aim to decrease the frequency and severity of headaches, while abortive drugs attempt to stop a headache that’s already underway. The risk for rebound may increase if you’re taking abortive headache medications three or more times per week. Importantly, the rebound effect can also diminish the effectiveness of preventative medications, including prescription medications.

A good rule of thumb to remember: If you have to take a particular pain medication every day to get rid of a headache, it’s not working.

Treating Rebound Headache: Getting Back to Your Baseline

When I suspect that a patient is rebounding on a headache medication, I immediately prioritize helping her or him transition off the offending drug. Besides providing relief from medication-induced symptoms, this step is very important in helping us determine whether chronic headaches are symptomatic of another problem. While many headaches have no known cause—these are known as idiopathic headaches—others can point to an underlying disease process, sometimes a serious one. When a rebound effect is masking other symptoms, it can be challenging to determine the true cause of a headache, a process that may require tests such as imaging studies.

Many patients are surprised at how much their headaches improve simply as a result of stopping the rebound cycle. Once we’ve succeeded in doing so, we can proceed to treat the underlying headache with an ever-broadening array of therapies, confident that a rebound effect isn’t constantly working against us.

Breaking a rebound cycle takes careful planning and coordination between physician and patient. Stopping medication abruptly is almost never a good idea; it’s better to work out a staged approach that will gradually loosen the medication’s grip. The particular plan we arrive at will depend on how the headaches manifest themselves, including their frequency, time of day or month, and any known triggers or lifestyle considerations. The goal is to get back to a baseline understanding of the patient’s condition, which is the starting point for proper diagnosis and effective treatment. Once the rebound effect is out of the picture, I can better assess the headache’s true behavior, including its frequency and any triggering factors, and recommend the best treatment to address it long-term.

Many patients are surprised at how much their headaches improve simply as a result of stopping the rebound cycle. Once we’ve succeeded in doing so, we can proceed to treat the underlying headache with an ever-broadening array of therapies, confident that a rebound effect isn’t constantly working against us.