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How do you stop rebound headaches?

One of our readers asks, “What is an effective way to stop rebound headaches? I’m getting migraines nearly every day. I try to ride it out, but can’t stand the pain, so I give in and take my triptan almost every time. I’ve tried prednisone tapers, but the pain keeps coming back. Help!”


Rebound headaches are caused by taking pain medicines too frequently over a prolonged period of time. Prednisone tapers may give temporary relief, but they don’t address the source of the problem. As you have experienced, the headache returns as soon as you stop taking the prednisone. Before we talk about solving the problem, let’s take a look at what it is and how it develops.

We just want to stop the pain.

The official diagnosis for rebound headache is Medication Overuse Headache. The name itself gives us clues as to how the problem is created. Migraine has several phases that produce debilitating symptoms. The most notorious one is the Headache Phase which can result in severe head pain that lasts up to 72 hours. None of us want to endure that, so we take medicines to stop the attack and relieve our pain.

What the experts tell us.

If migraine attacks occur more than twice month, headache experts usually recommend that we use a preventive treatment to reduce their frequency. That’s because migraine attacks have a tendency to increase in frequency and severity over time if not treated with preventives. The more attacks you have, the more often you will need to use abortive medication to stop the attacks. Unfortunately, taking any kind of pain medication, even triptans, more than 10 days a month puts you at risk for Medication Overuse Headache. That’s why most headache specialists recommend limiting the use of any combination of pain medicines to no more than 2 or 3 days a week.

It’s easy to get stuck in the trap.

Medication Overuse Headache doesn’t happen overnight. Getting caught in the cycle of medication overuse is very easy to do. After all, the medicine does stop our pain. If it didn’t, we wouldn’t keep taking it! The problem develops so gradually that we might not even realize until it’s too late.

Occasionally taking pain medicine more often for a limited time is sometimes necessary. Major dental work, surgery, or injuries can result in the need for more aggressive pain management. It’s important though, that we use daily pain medicines as briefly as possible. That’s because we run into problems when we make a long-term habit of using pain medicine, even over-the-counter remedies.

Fortunately, it can be corrected.

The solution is both simple and difficult. It is simple because all you need to do is stop taking pain medicine for 6-8 weeks. It is difficult because you must stop taking pain medicine for 6-8 weeks while your pain gets worse before it gets better.

This news usually sends people into a panic. When my doctor broke this news to me, I broke down crying and begged for another option. But there’s not another solution. It is difficult and painful to break Medication Overuse Headache. The good news is that this strategy does work. I’m living proof that breaking the cycle does reduce both the frequency and severity of pain.

For some people, the pain temporarily increases dramatically. That’s when your doctor can try several strategies to help you get through the process. In extreme cases, some people need to wean off medications under close supervision in a hospital.

Some doctors will start preventive treatment right away, while others will wait until the cycle has been broken. There is a 5-year study currently in the planning stages that is trying to determine which option is the best course of treatment. We won’t know the results for several more years, but hopefully we will finally get a definitive answer.

Ask your doctor for help.

In the meantime, talk to your doctor about getting help to break the cycle of medication overuse. If your doctor is not a headache specialist, you may want to consult with one before you try to stop. Given the level of pain you experience, a specialist may have options that increase your chances for success.

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.

  1. Bigal, M. E., Serrano, D., Buse, D., Scher, A., Stewart, W. F., & Lipton, R. B. (2008). Acute Migraine Medications and Evolution From Episodic to Chronic Migraine: A Longitudinal Population-Based Study. Headache: The Journal of Head and Face Pain, 48(8), 1157-1168. doi:10.1111/j.1526-4610.2008.01217.x
  2. Boe, M. G., Thortveit, E., Vatne, A., & Mygland, A. (2016, October 05). Chronic headache with medication overuse: Long-term prognosis after withdrawal therapy. Cephalalgia, 1-7. doi:10.1177/0333102416672493
  3. Determining the Optimal Treatment Strategy for Patients Who Have Chronic Migraine with Medication Overuse. (n.d.). Retrieved October 26, 2016, from http://www.pcori.org/research-results/2016/determining-optimal-treatment-strategy-patients-who-have-chronic-migraine
  4. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalgia. 2013; 33(9). Retrieved September 17, 2016 from http://www.ihs-classification.org/_downloads/mixed/International-Headache-Classification-III-ICHD-III-2013-Beta.pdf
  5. Tepper, S. J., & Tepper, D. E. (2010). Breaking the cycle of medication overuse headache. Cleveland Clinic Journal of Medicine, 77(4), 236-242. doi:10.3949/ccjm.77a.09147

Comments

  • Gracious
    10 months ago

    I kicked a horrible overuse cycle by simultaneously switching from triptans, which I wasn’t using that often, to ergotamine and cutting carbohydrates out of my diet severely. It worked great. I went from daily headaches to weekly headaches. And now I’m on aimovig and haven’t had a migraine in three months. Good luck to everybody.

  • Leslie Coutsouridis
    10 months ago

    I’ve had 24/7 chronic migraine for long periods of time. The longest was 13 months so I don’t understand the timing mentioned in the article. I have tried going without medication abortives for long periods of time as I bear it. It doesn’t help. It was impossible. I have tried all available treatments including hospitalizations. The good news is that I am experiencing great success with Amovig unless overdue my worst triggers or don’t pace myself. I finally have some semblance of a normal life although I lost my job.

  • kntruong
    10 months ago

    I’m already on 2 preventative meds plus botox. How exactly am I supposed to stop using all abortatives for 6 to 8 weeks without losing my job? I just don’t think this sounds realistic for many of us. I really don’t want to be an ER regular either.

  • mcgfsu
    9 months ago

    You shouldn’t go off the abortive/preventative meds, just stop the meds for when you get acute headaches like Imitrex, Fioricet, etc. because those meds are the meds that can be overused and cause the rebound headaches thereby becoming the problem. It’s happened to me twice several years apart. Once with Imitrex and once with Fioricet. Both times I had to stop those meds and take the Medrol Dose pack to break the rebound headache cycle because those meds no longer worked.

  • wappaw
    10 months ago

    I recently started down the path of the MOH, again for about the third time. I contacted my Neurologist and he prescribed Toradol to break the constant pain. I had recently been in the ER for kidney stone pain so he advised me to take no more than 3 days worth of pills, as my blood test had indicated an issue with kidney function. The Toradol did break the constant migraine cycle I was expierencing.

  • catwoman6325
    1 year ago

    If you break the cycle can you ever go back to trying those same medications like aspirin or Tylenol?

  • Dove1919
    1 year ago

    My doctors decided I had rebound headaches, though I disagreed. Still, they took me off all preventatives and stopped prescribing me pain meds six months ago. My head still hurts every day. I lost my job, am losing my house because I lost my job, will have to move in with family. I retired early on a very small pension. Most days I’m lucky if I make it out of bed. I cancel plans OFTEN. And I can’t go back to one of my doctors because he doesn’t accept my retirement insurance. When used properly, like I was doing, pain medicine will help people function. So not everyone whose taken off their meds for 6-8 weeks gets better. I’m proof of that.

  • mistycatbaby
    2 years ago

    I don’t think I could go six to eight weeks without some form of pain management. I’m sure I can’t. I did go three weeks for each of the pain clinics I went to. It was ghastly. I have always had migraines but they went from occasional to chronic after a head injury. What do you do for the pain? Migraine pain ranks right up there with my kidney stone attacks. The nausea is intense and the red hot needle that it feels like stuck in my skull is just plain debilitating.

  • wappaw
    2 years ago

    A number of years ago while on vacation I started experiencing rebound headaches, but I did not know it at the time. My headaches were coming every 12 hours. I would take my Imetrex / Sumatriptan and sleep for 5-6 hours. I would be good for a couple of hours and it would start all over. When I got home it continued the cycle. This was the first time I actually found a Migraine Doctor. He was able to manage my pain and break the cycle. I honestly don’t remember exactly what he did, but it worked. Now I try to not over use my medications, which flies in the face of the instructions to stop the headaches before they get too bad. Damned if you do, damned if you don’t.

  • wappaw
    2 years ago

    Sorry to say I think I am back in a overuse cycle. Because I am aware of MOH, I try to tough out the pain, after using my preventative meds; plus B2, magnesium, CoQ10. I hurt my back recently which seems to have triggered a nasty cycle of migraines. They have always followed the same pattern; the right side of my back starts to feel funny, then my shoulder and neck start to hurt / get super tight and painful, then all hell breaks loose. If I take the sumatriptan, 40 minutes later I am pain free. Unfortunately, as we all have been told, don’t abuse the meds, so I wait it out, which we all know is also the wrong thing to do unless you like pain. At this moment I can hardly conceive of no pain control for 6 – 8 weeks. I just find it so difficult to believe that this condition, and those similar to it, cannot be controlled, but after 40 years of suffering I guess I better start.

  • Paul
    2 years ago

    MOH is terrible. I don’t envy anyone dealing with that issue.
    Just a brief note on using naproxen… I see a headache specialist and as part of my medication regimen I was told to take 2 naproxen daily – one in the morning and one in the evening along with my preventative. It has actually helped in my treatment.
    I can’t speak as to whether this would be a good idea for anyone else. I’m just speaking of my own personal experience.

  • kelgar
    3 years ago

    I get a rebound migraine with even one dose of Imitrex, even if it is one tablet per year. I quit using triptans years ago for that reason. I have not found any analgesic to relieve migraine pain, and I don’t want to go down the narcotic path as I have frequent migraines. Now I take a sleeping pill and hope for the worst of the migraine to be over when I wake up.

  • DonnaFA moderator
    3 years ago

    Hi Kelgar, we’re glad that you’re here and appreciate you joining the conversation. I’m so sorry that you have been suffering without relief. Have you been able to connect with a headache specialist? You may want to check out Is It Time For a New Migraine Doctor? It may help you connect with a doctor who can helo you find some relief. – All Best, Donna (Migraine.com team)

  • Luna
    3 years ago
  • youkayn00b
    3 years ago

    Naproxen is a decent bridging medicine that can treat acute migraines while avoiding rebound pain, and diphenhydramine or dimenhydrinate can offer some relief off-label. I know the current thinking is to reject medicine entirely, but it doesn’t have to be that way

  • cheletwin2
    2 years ago

    I can’t sleep on benadryl when I have a headache. It may help with sinus congestion, but I’ve found it gives me the jitters and makes me more miserable.

  • youkayn00b
    3 years ago

    Some sources contend that naproxen carries less risk.

    Both diphenhydramine and dimenhydrinate can offer some pain-killing effect, not just as a booster, though it is off label so YMMV.

  • Tammy Rome author
    3 years ago

    Unfortunately, Naproxen carries the same MOH risk as any other OTC pain reliever. Headache specialists recommend limiting our total intake of any and all pain relievers to not more than 2-3 times per week. Exceeding this limit for more than 90 consecutive days increases our risk of developing MOH.

    Now diphenhydramine and medicines like it are not pain relivers. They can be used in addition to pain relievers or as comfort measure treatments when pain medicines fail.

    https://migraine.com/blog/help-how-can-i-not-overuse-migraine-medications/

  • RachelM
    3 years ago

    I broke the cycle 3 times. The first two failed because I didn’t have effective migraine prevention. The third time has stuck because I have effective prevention.
    I highly recommend effective presentation medication and more than one effective acute treatment. Oh and tapering worked well for me.

  • weezers
    2 years ago

    what prevention do you use/

  • DonnaFA moderator
    3 years ago

    Hi RachelM, thanks for sharing what works well for you. We’re glad that you’re part of the community! -All Best, Donna (Migraine.com team)

  • Tammy Rome author
    3 years ago

    Great tips and congrats on breaking out of MOH. It’s a tough thing to do. Keep up the good work!

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