Rebound headache

Rebound headaches, also known as medication overuse headaches, occur when pain medications (analgesics) are taken too frequently to relieve headache. Rebound headache can be caused by any painkiller or migraine abortive medication such as triptans as well as NSAIDs, antihistamines, and decongestants. [Tepper, Stewart J., M.D. "Migraine and Other Headaches." University of Mississippi Press. 2004] Over-the-counter agents such as aspirin, paracetamol/acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) as well as prescription medications such as Fioricet, Fiorinal, Imitrex and Vicodin can cause rebound headaches. The medications most likely to cause rebound appear to be the combination analgesics such as Fioricet, Fiorinal, and Excedrin, as well as narcotic medications. Rebound headaches frequently occur daily and can be very painful. They are a common cause of chronic daily headache. They typically occur in patients with an underlying headache disorder such as migraine, that "transforms" over time from an episodic condition to chronic daily headache due to more and more frequent analgesic use. Rebound headache was first described by Dr. Lee Kudrow. [PMID: 7055014 (Adv Neurol. 1982;33:335-41)]

Treatment

Rebound headache is common and can be treated. The overused medications must be stopped in order for the patient's headaches to resolve. This is usually done under the care of a neurologist. Often patients are started on preventive medications to ease their transition off the medications that induced the medication overuse / rebound cycle. It is important that the patient's physician be consulted before abruptly discontinuing medications as abruptly discontinuing some medications has the potential for creating another issue. Abruptly discontinuing butalbital, for example, can actually induce seizures in some patients, although simple over the counter analgesics can safely be stopped by the patient without medical supervision. A long acting analgesic/anti-inflammatory, such as Naproxen (500mg twice a day) can be used to ease headache during the withdrawal period. [Silberstein, Stephen D. & McCrory, Douglas C. (2001) "Butalbital in the Treatment of Headache: History, Pharmacology, and Efficacy." Headache: The Journal of Head and Face Pain 41 (10), 953-967.] [Loder, Elizabeth & Biondi, David (2003) "Oral Phenobarbital Loading: A Safe and Effective Method of Withdrawing Patients With Headache From Butalbital Compounds." Headache: The Journal of Head and Face Pain43(8), 904-909.]

Prevention

In general, any patient who has frequent headaches or migraine attacks should be considered as a potential candidate for preventive medications instead of being encouraged to take more and more painkillers or other rebound-causing medications. Preventive medications are taken on a daily basis. Some patients may require preventive medications for many years; others may require them for only a relatively short period of time such as six months. Effective preventive medications have been found to come from many classes of medications including neuronal stabilizing agents (aka anticonvulsants), antidepressants, antihypertensives, and antihistamines. Some effective preventive medications include Elavil (amitriptyline), Depakote (valproate), Topamax (topiramate), and Inderal (propranolol).

ee also

* rebound effect
* headache
* migraine
* tension headache
* Cluster headache

References