Skip to Accessibility Tools Skip to Content Skip to Footer

New research shows abnormal pain processing in medication overuse headache

A new study released in this month’s issue of Headache helps explain why medications designed to treat migraine can actually result in worsening of headache or medication overuse headache. Medication overuse headache—previously called rebound headache—occurs in about 1.5 percent of adults. Medication overuse headache is the exacerbation of an underlying headache disorder.

This worsening is caused by regularly using acute pain or migraine medications three or more days per week. About 65 percent of people with medication overuse headache have migraine as their underlying headache disorder. Discontinuing overused medications is the first step in treating medication overuse headache. For many people, headache frequency will decrease significantly after stopping medication overuse.

Medications most commonly causing medication overuse headache:

Regularly using pain pills or acute migraine medications causes changes in the nervous system. Researcher from Italy reported data from a new study using CO2 laser-evoked potentials to study how the brain processes pain signals in people with medication overuse headaches. The laser specifically activates pain fibers. Researchers can then study how the brain responds to pain sensations. Normally, nerves get bored of the same stimulation over and over again. So the brain reaction tends to decrease as the signal is repeated. This is called habituation. Earlier research showed that people with migraine tend to lose this habituation ability. Compared with people without migraine, the migraine brain is revved up and over-sensitive to pain signals. Another way to say this is that the migraine brain tends to be over-excitable to pain.

In the new study, CO2 laser-evoked potentials were studied in people with medication overuse headache while they were still overusing medications and then again after medications were no longer being overused. Researchers found loss of habituation when people were overusing medications. After medication overuse stopped, headaches decreased for about 60 percent of the people in this study. Testing found that habituation ability had improved as headaches decreased from daily headaches to infrequent headaches. Among those patients whose headaches did not improve after discontinuing overused medications, there was no improvement in habituation.

This study teaches several important lessons:

  • Pain processing is different in people with migraine. Migraineurs are more sensitive to pain signals than people without migraine.
  • Overusing pain medications or acute migraine drugs aggravates pain processing.
  • Medication overuse further decreases the migraine brain’s ability to habituate to pain signals, making the brain even more sensitive to pain.
  • Discontinuing overused medications can result in headache reduction that coincides with improved pain processing.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Ferraro, D., Vollono, C., Miliucci, R., Virdis, D., De Armas, L., Pazzaglia, C., Le Pera, D., Tarantino, S., Balestri, M., Di Trapani, G. and Valeriani, M. (2012), Habituation to Pain in “Medication Overuse Headache”: A CO2 Laser-Evoked Potential Study. Headache: The Journal of Head and Face Pain, 52: 792–807. doi: 10.1111/j.1526-4610.2012.02151.x

Comments

  • body
    7 years ago

    Thanks for sharing!! I was in the clinical trials for Imitrex. They tossed me out because of MVP but I convinced my neurologist to keep prescribing the pill for me as I thought it was my miracle cure. I ended up with rebound headaches and chronic migraine. Thank goodness a new internist told me I could not take the amount of medication I was consuming. I was forced to take responsibility for my health. A change in diet, lifestyle and the introduction of a number of integrative therapies like acupuncture and healing touch have given me my life back.

  • Renee Parker
    7 years ago

    Has anyone heard of the Reed migraine procedure? It the reed migraine center in Texas ?

  • Marcia Bachochin
    7 years ago

    I saw a doctor who’s motto was “Everybody suffers from overuse of medication” or in other words “You are a bunch of drug addicts!” Everyone in the community RAVES about him. Well, he basically blames his patients for the sufferings. Tells his patients as well that if you don’t want to follow my plan, I won’t waste my time on you. Thinks he’s a freaking God! I too stopped rebounding meds for a bit with little improvement. Also I know the difference between a rebound headache and a migraine. You need to find the right doctor for you who respects you and is willing to accept you as a knowledgeable person in the field of migraines! I had a great doctor back where I am originally from. I had to move and that’s when I saw that quack I was talking about. You have to do some exploring to find the right one.

  • 'Tracey-Ann Morgan
    7 years ago

    Thanks for the information. I have read many article on this subject.. I have no choice but to take Opioids for my Migraines. I have 3/5 attacks aweek. with daily H/a. I have done the no painkillers for 4 /5months. My H/A did not decrease in that time…… Tried many prevention meds.I’m allergic to Triptans….
    I do worry about rebound H/A. I’d rather not take pain meds but I’m left with no other option. My Dr says this is all I can take even with the ricks of Rebound.
    I would love to find a different way of managing them.

  • Tara Lane
    7 years ago

    I have had 43 years of migraines. They are now intractable, although I was told they would go away with menopause. With menopause they got worse and I started getting visual auras to boot. I have had 43 years of multiple drug combinations that will fill, single spaced two columns of 2 pages. I have been hospitalized at a well known clinic, and they could not get my migraine (yes let us call it what it is, a migraine) to stop after 8 days, and needed steroids to get me off the other IV drugs they were using. I have gone off all meds for 2 years and tried alternative therapies. I returned to the allopathic method because it was just too painful without some medication. I have a very high pain tolerance. I am one of the people in the category that waits to see if it is a severe migraine before I take the medication. I can say “overuse of drugs aggravates pain processing” and “a discontinuation of overused medications can result in headache reduction” is a oversimplified statement that should be used with care and directed only, and I mean ONLY at those folks who are at the very beginning of the migraine journey and have not even identified that those pesky headaches they have are, indeed, migraines. This is something that was clear in the mid-eighties when I was hospitalized in the clinic, and is not news. The testing that is being done may give further information about this fact, but it is still old hat.

    When will you guys get it? Of all the articles on all the websites, yours is definitely the best. I have recommended it to many people, including all my (many) physicians – some who know little about migraines- but know a lot more now, including the required reading I give them if I choose to work with them. I give it to friends and others who seem to have and interest. Having said that, this article is for the neophyte and should be identified as such. Now I am done being kind. What I am is hopping mad that you would even post such an article.

    Having been at it for such a long time, and gone up and down with the ebbs and flows along with the research of the migraine community, there is one thing I can say for sure, I KNOW MY OWN BODY, as do most migraineurs who use this site. I do not ever, ever, overuse medications. In fact, if anything, I underuse medications. I have a migraine almost every day of the year. If it is below a level 5, I deal with it. I do the best I can to function, and know that I have a high tolerance for pain, stick to my regimen of diet, exercise, rest, and sleep, and try not to be depressed that I am alone much of the time, because I cannot go out as much, or do the things others do because of this disease. We all have things to deal with, this is mine. But I do not overuse my meds. Ask my docs.

    However, after 43 years and a list of medications that would make your eyes bulge, my body does not tolerate medications the way it did when I was younger. So I am doubly careful to keep meds out of the rebound (MOH) area, because a rebound headache is nothing to sneeze at and if these docs who are conducting these surveys have ever had one, perhaps they would go back to calling them what they are: REBOUND HEADACHES! There is nothing one can do for a rebound headache except wait it out. It is usually at a 7-9 pain level. I use ice, heat, try to sleep, knowing the pain is use going to be there until it isn’t, get up and walk my dog once a day, eat if I can, take my regular meds, and wait it out. It usually takes 2 to 2 1/2 days. At the end of all this I am physically exhausted. It takes about 3 days to get my strength back and back into some kind of daily routine. It is not fun, it is not easy, and it is not something I look to have by taking medication absent-mindedly or because I “feel a little pain in my head.” Now that would be stupid.

    It is not some politically correct sounding “Medication Overuse Headache” which puts the responsibility and cause right back on the patient and makes them the victim of their own migraines, which believe me, they don ‘t need. HOW DARE YOU! Here we are trying to get out of this mode, and you, the migraine community, are throwing it back on us! I thought we were done with this topic, and now it being thrown back in our faces!

    I am sure you did not intend for this to be taken in this fashion, but perhaps another read through will give you some more perspective on what migraneurs are living with.

    I cannot help it if my internal system rejects a medication that I have been carefully using, per direction, prescribed by my migraine specialist doc to get rid of the pain in my head. My system is very sensitive. I cannot tolerate the pain all the time. I have to give some of this back to the “migraine specialists” in the past who put me on some of these “medications” that did not do much for my migraines, but did tear up my insides quite nicely, even when I faithfully reported I was having trouble, nothing was done.

    In the end I am my own advocate, and I cannot rely on the medical community to do anything more than give me the information, and work with me to try and find solutions that work for me and my body. I get angry from time to time. I do the best I can. The medical community works hard researching new information, and our advocates, like this website I know work very hard to bring us the best information. Everyone is doing the best they can. I know this and I thank you all for it.

    But please, please, keep out the old stuff. And call a spade a spade. Thanks for listening.

  • taralane
    7 years ago

    I have had 43 years of migraines. They are now intractable, although I was told they would go away with menopause. With menopause they got worse and I started getting visual auras to boot. I have had 43 years of multiple drug combinations that will fill, single spaced two columns of 2 pages. I have been hospitalized at a well known clinic, and they could not get my migraine (yes let us call it what it is, a migraine) to stop after 8 days, and needed steroids to get me off the other IV drugs they were using. I have gone off all meds for 2 years and tried alternative therapies. I returned to the allopathic method because it was just too painful without some medication. I have a very high pain tolerance. I am one of the people in the category that waits to see if it is a severe migraine before I take the medication. I can say “overuse of drugs aggravates pain processing” and “a discontinuation of overused medications can result in headache reduction” is a oversimplified statement that should be used with care and directed only, and I mean ONLY at those folks who are at the very beginning of the migraine journey and have not even identified that those pesky headaches they have are, indeed, migraines. This is something that was clear in the mid-eighties when I was hospitalized in the clinic, and is not news. The testing that is being done may give further information about this fact, but it is still old hat.

    When will you guys get it? Of all the articles on all the websites, yours is definitely the best. I have recommended it to many people, including all my (many) physicians – some who know little about migraines- but know a lot more now, including the required reading I give them if I choose to work with them. I give it to friends and others who seem to have and interest. Having said that, this article is for the neophyte and should be identified as such. Now I am done being kind. What I am is hopping mad that you would even post such an article.

    Having been at it for such a long time, and gone up and down with the ebbs and flows along with the research of the migraine community, there is one thing I can say for sure, I KNOW MY OWN BODY, as do most migraineurs who use this site. I do not ever, ever, overuse medications. In fact, if anything, I underuse medications. I have a migraine almost every day of the year. If it is below a level 5, I deal with it. I do the best I can to function, and know that I have a high tolerance for pain, stick to my regimen of diet, exercise, rest, and sleep, and try not to be depressed that I am alone much of the time, because I cannot go out as much, or do the things others do because of this disease. We all have things to deal with, this is mine. But I do not overuse my meds. Ask my docs.

    However, after 43 years and a list of medications that would make your eyes bulge, my body does not tolerate medications the way it did when I was younger. So I am doubly careful to keep meds out of the rebound (MOH) area, because a rebound headache is nothing to sneeze at and if these docs who are conducting these surveys have ever had one, perhaps they would go back to calling them what they are: REBOUND HEADACHES! There is nothing one can do for a rebound headache except wait it out. It is usually at a 7-9 pain level. I use ice, heat, try to sleep, knowing the pain is use going to be there until it isn’t, get up and walk my dog once a day, eat if I can, take my regular meds, and wait it out. It usually takes 2 to 2 1/2 days. At the end of all this I am physically exhausted. It takes about 3 days to get my strength back and back into some kind of daily routine. It is not fun, it is not easy, and it is not something I look to have by taking medication absent-mindedly or because I “feel a little pain in my head.” Now that would be stupid.

    It is not some politically correct sounding “Medication Overuse Headache” which puts the responsibility and cause right back on the patient and makes them the victim of their own migraines, which believe me, they don ‘t need. HOW DARE YOU! Here we are trying to get out of this mode, and you, the migraine community, are throwing it back on us! I thought we were done with this topic, and now it being thrown back in our faces!

    I am sure you did not intend for this to be taken in this fashion, but perhaps another read through will give you some more perspective on what migraneurs are living with.

    I cannot help it if my internal system rejects a medication that I have been carefully using, per direction, prescribed by my migraine specialist doc to get rid of the pain in my head. My system is very sensitive. i cannot tolerate the pain all the time. I have to give some of this back to the “migraine specialists” in the past who put me on some of these “medications” that did not do much for my migraines, but did tear up my insides quite nicely, even when I faithfully reported I was having trouble, nothing was done.

    In the end I am my own advocate, and I cannot rely on the medical community to do anything more than give me the information, and work with me to try and find solutions that work for me and my body. I get angry from time to time. I do the best I can. The medical community works hard researching new information, and our advocates, like this website I know work very hard to bring us the best information. Everyone is doing the best they can. I know this and I thank you all for it.

    But please, please, keep out the old stuff. And call a spade a spade. Thanks for listening.

  • Dawn A Marcus
    7 years ago

    There are indeed a small number of people who do best taking low doses of acute medications frequently. But, in my experience, this is very rare and it’s important to have a good trials of months off of the drugs to make certain the drugs are not aggravating an underlying migraine problem. It’s much more common that one thinks the drugs are helping until diaries while on drugs are compared with those taken after being off drugs for several months.

  • Dawn A Marcus
    7 years ago

    I think the important information from this study is that it reinforces that migraine is caused by real, underlying biological changes in the nervous system that explain why migraines are more than just the “regular headaches” most people get. Also, this study confirms that overusing pain medications causes an aggravation in the physiological changes migraineurs experience that supports why overusing drugs typically aggravates migraine.

  • Dawn A Marcus
    7 years ago

    When people have frequent migraines, acute medications can only be used for unusually severe migraines to avoid aggravation from medication overuse. Frequent migraines generally need to be treated with prevention therapies, which work differently. I have never had a patient who believed me when I said medication overuse was likely a problem — until they got off of the overused medications. For about half of those discontinuing overused medications, headaches improve — often dramatically. For the other half, coming off the overused medications allows their nervous system to become more responsive to prevention therapies. Unfortunately, prevention therapies are generally ineffective when medications are being overused. It’s a very difficult problem since you really can’t get the headaches better before getting rid of the excess medications. The good news, however, is less than 10 percent of people experience headache worsening after discontinuing overused drugs.

  • Louise M. Houle
    7 years ago

    Indeed, that is good news for some. And I thank you for your article. So important to educate people, especially those with episodic migraines who may be prone to developing chronic migraine. However, what about those of us (the less than 10 percent) who do not improve after stopping to overuse medications? As many have stated, we cannot live in severe pain day after day. The only way I can function is to take Triptans on a regular basis. I won’t go into everything I’ve tried – but it has been over 10 years of various preventatives, cocktails, as well as withdrawing protocols… I’d rather live with daily rebound low level pain headaches than severe migraine pain. Fortunately, my specialists understand this and are OK with prescribing the meds I need to manage. Good luck all. Hope we find a treatment soon for chronic retractable migraines.

  • Janene Zielinski
    7 years ago

    Has anyone else ever had a migraine specialist tell you to take a triptan as a preventative if you thought you might be in a situation that would trigger a migraine? Since I have a million triggers, practically daily, I can only see this being a problem. I didn’t take his advice.

  • Dawn A Marcus
    7 years ago

    Triptans have been shown to successfully prevent menstrual migraine when used for a couple days before your expected period. (This of course only works if you have very regular and predictable periods.) We also did a research project showing that pre-treatment with a single dose of a triptan could prevent the development of motion sickness. While some prevention therapy with very short courses triptans used infrequently may be helpful, you are correct that trying to address many frequent triggers would likely put you at risk for developing medication overuse headache.

  • Kris McGuire
    7 years ago

    I’m curious as to what we’re supposed to do instead of medicating a migraine, even at the risk of overuse (and like one person below, I’m a bit skeptical). Spend an entire day, or up to three or four days, in bed, vomiting and in pain, unable to eat or sometimes shower, to the detriment of our families and jobs?

  • Renee Parker
    7 years ago

    I too would like to know what do we do instead? Most don’t have the ability to lose several days a week in bed not to mention insure the pain. So what do we do? How do we use less medication? I have tried hypnosis, acupuncture, relaxation tapes, ect. Nothing works

  • Kris McGuire
    7 years ago

    Jody, I know what you mean — I can’t imagine that *not* crossing someone’s mind after a while.

    P.S. Dilaudid kind of rules. I mean, for the two and a half minutes until it knocks you out, anyway.

  • Suzy Lane Smith
    7 years ago

    I agree that when you have a migraine you could care less about studies. I usually have To take something for several days in a row and then I may get a week or two off. Seems like at least for me, this means no rebound headache from my Excedrin.

  • Jody Hardison
    7 years ago

    In my late teens i started having cluster migraines to the point that I was incapacitated for weeks at a time. They had me on serious narcotics, including Diluadid. I considered suicide several times because of it. This study is flawed.

  • Wendi Milasi
    7 years ago

    Amen.

  • Kris McGuire
    7 years ago

    I’ve had the one I have now on and off since Monday, and I can’t go to an ER. The only way I’ve gotten anything done this week — including getting dressed — is thanks to Maxalt and Fioricet. I’m fairly certain whoever’s in charge of this study has never had a migraine in his or her life.

  • Wendi Milasi
    7 years ago

    Toughen up woman! 😉

  • Sally Colby Scholle
    7 years ago

    This is why I take diazepam when a migraine lasts more than 12 hours. I’ve found that the very thought of the migraine continuing (and taking more meds) makes me tense, which makes my neck stiff, which makes me tense…you get the idea. I really think diazepam helps break the cycle, and I don’t have to use it more than about once a week.

  • Fiona Fletcher
    7 years ago

    Unless there is further information not included in this article, then this study is fundamentally flawed. It states that research was carried out on those with migraine overuse headache. At the moment there is no sure way to determine if severity and/or frequency of migraines in individuals is down to this cause alone, or to some other factor. Also, since other conditions can exist simultaneously with migraine, it is reasonable to assume that people will be taking painkillers for other conditions such as fibromyalgia, arthritis etc. It is also not unreasonable to assume that someone who stops taking painkillers for their arthritis in eg, the neck or back, may actually exacerbate their migraines by the increased pain of those conditions actually triggering them.

  • Louise M. Houle
    7 years ago

    Fiona, you are so right. I think one of the reasons my migraines transformed from episodic to chronic is that I developed Psoriatic arthritis (quite painful) and had to take anti-inflammatories on a daily basis. Catch 22 situation. I, unfortunately, do not have a high tolerance for pain.

  • Kathy Jo Horton Bishop
    7 years ago

    I have to disagree…on some aspects they thought mine were from overuse…after discontinuing all pain meds for over three months my headaches/migraines were worse I’ve been trying to tell my docs what worked and somewhere along the way cause everyone else was using a different combo they stopped using what worked for me and forced me to try an onslaught of horendous drugs that made me sicker than ever because they were the go to drug…drug companies need to stop pushing the newest designer meds if the old ones are working…just saying.

  • Vicki Thompson
    7 years ago

    Wow, this is wonderful information! It’s so nice to have answers/confirmation to problems/questions you’ve had for years. Thank you to the researchers working on the Migraine Disease.

  • Poll