Medication Overuse Headache

If you suffer from migraine, you may have heard of the term rebound headache, also known as medication overuse headache. This is a type of headache that has been linked to excessive use of some acute medicines. These medicines may be prescription or over-the-counter (OTC) drugs taken to treat head pain, as well as migraine. However, if you take these medications more than a few days a week, they can cause medication overuse headache.1,2

Medication overuse headaches are common. They occur in about 1 or 2 out of every 100 people. These headaches are more common in women and in people who have chronic pain, depression, or anxiety.3

Symptoms of medication overuse headache

When you suffer from medication overuse headache, you may have head pain every day (or almost every day). Often, this head pain will wake you up in the morning. The pain may improve when you take medicine, but it returns as the medicine wears off.1

Other symptoms of medication overuse headache include:1

What causes medication overuse headaches?

Medication overuse is defined by how much acute medication you take per month. Acute medication is a medicine used to stop a migraine, as opposed to preventing one. These medicines and ingredients may cause medication overuse headaches:2

  • Simple analgesics: Products with 1 ingredient, like aspirin, Tylenol (acetaminophen), ibuprofen, or naproxen, can cause medication overuse headache if you take more than the recommended daily dosage or if you use them for 15 or more days per month
  • Combination pain medications: Medicines like Excedrin Migraine, which contain a combination of ingredients, can cause rebound headaches if you take them for 10 or more days per month
  • Triptans like Imitrex (sumatriptan) may lead to rebound headaches if used for 10 or more days per month
  • Opioids such as oxycodone, tramadol, or hydrocodone can cause rebound headaches if used for 10 or more days per month
  • Caffeine intake over 200 mg per day can increase the risk of rebound headaches

Diagnosing medication overuse headache

There is not a specific test for medication overuse headache. Your doctor will go over your history and the medicines you take and how often you take them. He or she can usually diagnose you based on this information. Occasionally, the doctor will order additional lab work or imaging studies.2

Treating medication overuse headache

A headache specialist can help you treat medication overuse headache. Rebound headaches can get worse unless you get proper treatment.

Your doctor can help you make a treatment plan. He or she might prescribe medicines to prevent migraine. Your doctor might also prescribe drugs to treat a migraine when you get one. Your doctor can instruct you on how to slowly come off the medicines that were causing rebound headaches.4

At first, your headaches may feel worse. Your specialist should monitor you closely. Soon, with proper treatment, your medication overuse headaches should stop, and you should have fewer migraine attacks.4

Things to consider

A headache specialist can treat medication overuse headaches. Talk to your headache specialist about preventive medicine. Make a treatment plan for when you do get a migraine.

People who suffer from migraine often find support through online forums or social media groups. These groups can be beneficial, but be sure to only take medical advice from your doctor.

Keep a migraine diary (or use an app), which will help you identify triggers and patterns, and share the information with your doctor.

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Written by: Karen Berger | Last reviewed: October 2020