How do you stop rebound headaches?
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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.

view references
  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
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