{"id":37778,"date":"2021-08-17T09:30:47","date_gmt":"2021-08-17T13:30:47","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=37778"},"modified":"2024-05-22T14:54:26","modified_gmt":"2024-05-22T18:54:26","slug":"medication-overuse-headache","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/medication-overuse-headache\/","title":{"rendered":"Can you get a headache from treating your headache? Medication overuse explained"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">You have a headache so you reach for a couple of Tylenol, aspirin, or maybe something your healthcare provider prescribed. It\u2019s a common routine played out by millions of people every day. For most, it\u2019s an effective remedy. The pain medication gets to work and the headache goes away.\u00a0<\/span><\/p>\n<p><span data-sheets-root=\"1\" data-sheets-value=\"{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}\" data-sheets-userformat=\"{&quot;2&quot;:6849,&quot;3&quot;:{&quot;1&quot;:0},&quot;9&quot;:1,&quot;10&quot;:2,&quot;12&quot;:0,&quot;14&quot;:{&quot;1&quot;:2,&quot;2&quot;:0},&quot;15&quot;:&quot;Arial&quot;}\" data-sheets-formula=\"=CONCATENATE(R[0]C[-2],R[0]C[-3],R[0]C[-1])\"><\/span><\/p>\n<p><span style=\"font-weight: 400;\">But for some people\u2014especially those with recurrent headache disorders such as chronic <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/migraine-definition\/\"><span style=\"font-weight: 400;\">migraine<\/span><\/a><span style=\"font-weight: 400;\"> or <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/pharmacist-knows-best-migraine\/\"><span style=\"font-weight: 400;\">cluster headaches<\/span><\/a><span style=\"font-weight: 400;\">\u2014long-term or frequent use of pain relievers can trigger what\u2019s known as medication overuse headaches (MOH).<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is a medication overuse headache?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A medication overuse headache, also known as a rebound headache, is a regular headache that stems from the repeated or excessive use of acute pain-relieving medications. Here\u2019s what happens: The medication quells the pain for a few hours, but as it starts to wear off and the pain is no longer suppressed, the headache \u201crebounds.\u201d So you take more medication\u2014which can become less effective with repeated use. The medication again tapers off and the headache returns. Again. It\u2019s a vicious cycle that can lead to the development of a chronic daily headache that produces more and more disabling pain. This type of headache can be caused by over-the-counter medications, like aspirin or acetaminophen, or prescription drugs, such as migraine medications like triptans.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Whether an MOH is a headache that\u2019s secondary to the one that first made you reach for pain medication or a continuation of the original one is a matter that\u2019s debated by researchers. According to the <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4959634\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">International Headache Society<\/span><\/a><span style=\"font-weight: 400;\">, people with medication overuse headaches are typically people with a headache disorder, such as episodic migraines. The diagnostic criteria listed in the international classification of headache disorders specify that patients have headaches 15 or more days per month, regularly take pain medications 10 or more days a month for three or more months, and the headache can not be classified as any other medical condition.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cDevelopment of medication overuse is linked to the baseline frequency of headache days per month and acute medication class used, among other risk factors,\u201d says <\/span><a href=\"https:\/\/www.ochsner.org\/doctors\/cristina-cabret-aymat\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Cristina Cabret-Aymat, MD<\/span><\/a><span style=\"font-weight: 400;\">, a neurologist and headache care specialist at Ochsner Health Center in Covington, Louisiana.\u00a0<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/how-long-do-migraines-last\/\"><b>How long do migraines last?<\/b><\/a><\/p>\n<h3><span style=\"font-weight: 400;\">Who\u2019s at risk?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">\u201cMedication overuse headaches most commonly occur in people with primary headache disorders like migraine or tension-type headache who use less effective or nonspecific medications resulting in an inadequate treatment response with the need to repeat dosing,\u201d explains <\/span><a href=\"https:\/\/hartfordhealthcare.org\/find-a-doctor\/physician-detail?id=003j000000aslhJAAQ\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Brian Grosberg, MD<\/span><\/a><span style=\"font-weight: 400;\">, director of the Hartford HealthCare Ayer Neuroscience Institute Headache Center in West Hartford, Connecticut. According to experts at the <\/span><a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/6170-medication-overuse-headaches\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Cleveland Clinic<\/span><\/a><span style=\"font-weight: 400;\">, medication overuse headaches occur three times more often in women than men and are most common in midlife.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medication overuse headaches are rare in the general population. According to current <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538150\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">research<\/span><\/a><span style=\"font-weight: 400;\">, 2.6% of people live with them. However, they\u2019re very common in those with persistent headaches. In fact, up to 70% of people with chronic daily headaches get headaches from medication overuse. What\u2019s more, \u201cPeople with migraine could develop overuse even if they\u2019re using the <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/analgesics\"><span style=\"font-weight: 400;\">analgesics<\/span><\/a><span style=\"font-weight: 400;\"> [drugs that relieve pain] for other medical conditions,\u201d Dr. Cabret-Aymat says.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Symptoms<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Symptoms of medication overuse headaches include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headaches that occur daily or almost daily<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headache pain that decreases with pain-relieving drugs, but returns as the drugs wear off<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headaches that start in the morning, often upon waking\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">That\u2019s because by the time the sun comes up, the pain-relieving drug you took before sleep will most likely have worn off. Pain can be dull or stabbing, and last <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22868543\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">four or more<\/span><\/a><span style=\"font-weight: 400;\"> hours a day. And thanks to that debilitating pain, you may also experience certain side effects such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nausea<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Difficulty concentrating<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Problems sleeping<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Irritability<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Depression or anxiety<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">What drugs cause medication overuse headaches?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">No one\u2019s really sure what causes medication overuse headaches. But there are some theories. In the case of migraines, for example, \u201cstudies suggest that the overuse of acute medications may cause changes in the nervous system of headache-prone patients that result in a reduced threshold for experiencing migraine and an enhanced sensitivity to stimuli that trigger migraine,\u201d reports Dr. Grosberg.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The list of medications that can cause a medication overuse headache is long. Pretty much anything you might reach for to <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/migraine-treatment-and-medications\"><span style=\"font-weight: 400;\">relieve a headache<\/span><\/a><span style=\"font-weight: 400;\"> or other type of pain has\u2014if used regularly or excessively\u2014the potential to trigger an MOH in certain people. According to the Cleveland Clinic, these drugs include:<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Over-the-counter medications<\/span><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Simple analgesics like aspirin, Tylenol (acetaminophen), and <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/nsaids\"><span style=\"font-weight: 400;\">nonsteroidal anti-inflammatory drugs (NSAIDs)<\/span><\/a><span style=\"font-weight: 400;\">, including Advil (ibuprofen),Aleve (naproxen), and aspirin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Combination analgesics, such as medications that combine pain relievers and caffeine (Excedrin and Anacin)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drugs that treat sinus pain<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Prescription medications<\/span><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/opioids\"><span style=\"font-weight: 400;\">Opioids<\/span><\/a><span style=\"font-weight: 400;\">, such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/acetaminophen-codeine-3\"><span style=\"font-weight: 400;\">Tylenol (acetaminophen) with codeine<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/oxycodone-vs-oxycontin\/\"><span style=\"font-weight: 400;\">OxyContin (oxycodone)<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/percocet-vs-vicodin\/\"><span style=\"font-weight: 400;\">Vicodin (hydrocodone\/acetaminophen)<\/span><\/a><span style=\"font-weight: 400;\">, and <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/percocet-vs-vicodin\/\"><span style=\"font-weight: 400;\">Percocet<\/span><\/a><span style=\"font-weight: 400;\"> (oxycodone\/acetaminophen)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ergotamine-containing drugs such as Ergomar, Migergot, and Bel-Phen-Ergot S. For many people, headaches occur when blood vessels in the head expand and press against sensitive nerve endings. Ergotamine works by constricting those blood vessels and reducing pain.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Butalbital-containing drugs such as Fiorinal and Fioricet. Butalbital is a <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/barbiturates\"><span style=\"font-weight: 400;\">barbiturate<\/span><\/a><span style=\"font-weight: 400;\"> and acts as sedative. It\u2019s typically combined with aspirin and caffeine.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Triptan-containing drugs such as Imitrex (sumatriptan), Zomig (zolmitriptan), and Maxalt (rizatriptan). <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/triptans\"><span style=\"font-weight: 400;\">Triptans<\/span><\/a><span style=\"font-weight: 400;\"> help to calm overactive pain nerves and stop vasodilation and inflammation.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">So how much of a medication can produce a medication overuse headache? It depends on the medication used and for how long. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538150\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Research<\/span><\/a><span style=\"font-weight: 400;\"> indicates you can develop an MOH when you take:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NSAIDs such as ibuprofen and naproxen for 15 days a month<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Combined analgesics, such as drugs that blend things like codeine with aspirin, for 10 days a month<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription medications such as triptans and ergotamines for 10 days a month<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Opioids for eight days or more per month<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Butalbital-containing compounds (like Fioricet) for five days a month\u00a0<\/span><\/li>\n<\/ul>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/ibuprofen-dosage\/\"><b>How much ibuprofen is safe to take?<\/b><\/a><\/p>\n<h2><span style=\"font-weight: 400;\">How to treat rebound headaches<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Management of medication overuse headaches typically involves the discontinuation (or, in some cases, the reduction) of the overused medication. Research indicates that what clinicians call withdrawal therapy, or detoxification, is effective in reducing the prevalence of medication overuse headaches in about <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5741367\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">50% to 70%<\/span><\/a><span style=\"font-weight: 400;\"> of patients. But given that you\u2019re regularly reaching for painkillers because your headaches are frequent and intense, medication withdrawal is easier said than done. Withdrawal symptoms can include an initial worsening of the headache (aka withdrawal headaches) along with nausea, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/blood-pressure-levels\/\"><span style=\"font-weight: 400;\">low blood pressure<\/span><\/a><span style=\"font-weight: 400;\">, vomiting, anxiety and problems sleeping. These can last an agonizing one-to-two weeks.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">But before you decide to stop or taper off your medication, it\u2019s important to get your healthcare provider\u2019s guidance. Some people can handle the medication detoxification at home, but others need in-patient treatment. In some cases your doctor will want to reduce your medication use gradually, in others it may be okay to stop abruptly. \u201cIn the meantime, we can do bridge therapy to help patients come off the overused drugs while providing symptomatic relief,\u201d says Dr. Cabret-Aymat. For example, someone taking triptans may be prescribed a newer drug type called gepants (<\/span><a href=\"https:\/\/www.singlecare.com\/blog\/news\/ubrelvy-ubrogepant-migraine\/\"><span style=\"font-weight: 400;\">Ubrevly<\/span><\/a><span style=\"font-weight: 400;\"> is one), which can be used to prevent or abort a migraine and are less likely than triptans to cause a medication overuse headache. Gepants can be intravenous or oral medications.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/prescription\/ubrelvy\"><b>Get free Ubrevly coupons<\/b><\/a><b> | <\/b><a href=\"https:\/\/www.singlecare.com\/prescription\/ubrelvy\/what-is\"><b>What is Ubrevly?<\/b><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Some common bridge therapy options include:<\/span><\/p>\n<ul>\n<li aria-level=\"1\"><b>Physical therapy: <\/b><span style=\"font-weight: 400;\">This type of therapy can help to manage pain and improve mobility\u2014especially for certain types of migraine.<\/span><\/li>\n<li aria-level=\"1\"><b>Biofeedback:<\/b><span style=\"font-weight: 400;\"> This technique teaches people how to control bodily processes like breathing and muscle tension. Biofeedback can reduce headache frequency by <\/span><a href=\"https:\/\/mhni.com\/headache-pain-faq\/non-drug-treatment-alternatives\/biofeedback-and-relaxation\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">45% to 60%<\/span><\/a><span style=\"font-weight: 400;\"> in people with migraine and tension-type headaches.<\/span><\/li>\n<li aria-level=\"1\"><b>Transcutaneous electrical nerve stimulation (TENS):<\/b><span style=\"font-weight: 400;\"> TENS delivers low-voltage electrical currents to stimulate nerves and help bring pain relief. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5975046\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Research<\/span><\/a><span style=\"font-weight: 400;\"> shows it can significantly reduce the number of days per month users have headaches.<\/span><\/li>\n<li aria-level=\"1\"><b>Use of non-analgesic medications to control symptoms:<\/b> <a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/6170-medication-overuse-headaches\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Prescription drugs<\/span><\/a><span style=\"font-weight: 400;\"> such as alpha and beta blockers, blood pressure medications, and antidepressants may be used to ease the symptoms of medication withdrawal in some cases.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Prevention<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">It\u2019s common sense: The fewer headaches you get, the lower your chance of medication overuse headaches. And that makes preventive treatment key. To reduce headache frequency:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Steer clear of known headache triggers<\/b><span style=\"font-weight: 400;\">\u2014for example, if you know chocolate, alcohol, or stress tend to bring on an acute migraine, try to avoid those things.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Take your headache medication as prescribed. <\/b><span style=\"font-weight: 400;\">Don\u2019t add on doses or take more than recommended unless you first follow up with your healthcare provider.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Talk to your provider if you have a headache more than four days a month.<\/b><span style=\"font-weight: 400;\"> You may need to take a prophylactic, or preventive medication, such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/botox\/what-is\"><span style=\"font-weight: 400;\">Botox<\/span><\/a><span style=\"font-weight: 400;\"> (onabotulinumtoxinA). In <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4695480\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">one study looking at the use of Botox<\/span><\/a><span style=\"font-weight: 400;\"> in people with chronic migraines and medication overuse headaches, Botox reduced the number of headache days and the number of days subjects took medication compared to baseline.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Avoid butalbital-containing medications or opioids. <\/b><span style=\"font-weight: 400;\">These have a high likelihood of producing medication overuse headaches.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">As vexing and disabling as chronic headaches can be, there is hope for breaking the medication overuse cycle. Treatment of medication overuse headaches may involve trying <a href=\"https:\/\/www.singlecare.com\/blog\/new-migraine-medications\/\">newer drugs<\/a> less likely to cause rebound headaches and nondrug therapies that can bring pain relief. There are also preventive medications that can stop a headache before it even starts.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8220;Acute and preventive headache treatment should be individualized to each patient, considering comorbidities, risk factors, and side effects,\u201d Dr. Grosberg says. Ultimately, you need to talk to your healthcare provider about your options.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cThere\u2019s not one universal medication for acute headache management that works for everyone,\u201d adds Dr. Cabret-Aymat. \u201cThis has to be tailored to the patient\u2019s needs.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>You have a headache so you reach for a couple of Tylenol, aspirin, or maybe something your healthcare provider prescribed. It\u2019s a common routine played out by millions of people every day. For most, it\u2019s an effective remedy. The pain medication gets to work and the headache goes away.\u00a0 But for some people\u2014especially those with [&hellip;]<\/p>\n","protected":false},"author":94,"featured_media":37826,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8029],"tags":[788,4316],"coauthors":[10462],"class_list":["post-37778","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-education","tag-drug-safety","tag-migraine","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>How to prevent and treat medication overuse headaches<\/title>\n<meta name=\"description\" content=\"Triptans and other drugs can cause medication overuse headaches, also known as rebound headaches. 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