Medication overuse headaches

Diagnosis

Your healthcare professional most often can diagnose medication overuse headaches based on your history of headaches and your use of medicine. Most people don't need testing. People who are diagnosed with medication overuse disorder have a headache condition, have headaches on 15 or more days a month for more than three months, and take too much headache medicine.

Treatment

A vital part of treatment is learning about medication overuse headaches and other ways to relieve pain. To break the cycle of medication overuse headaches, you'll need to stop or cut down on pain medicine. Your healthcare professional may advise stopping the medicine right away or lowering the dose little by little.

Breaking the cycle

When you stop your medicine, expect headaches to get worse before they get better. You may depend on some medicines that result in medication overuse headaches. Withdrawal symptoms may include:

• Nervousness.
• Restlessness.
• Nausea.
• Vomiting.
• Insomnia.
• Constipation.

These symptoms most often last 2 to 10 days. But they may go on for weeks.

Your healthcare professional may prescribe treatments to help with headache pain and the side effects of medicine withdrawal. This is called bridge or transitional therapy. Treatments may include nonsteroidal anti-inflammatory drugs, corticosteroids, nerve blocks and anti-nausea medicines. Your healthcare professional also might suggest that you take the ergot dihydroergotamine through a vein.

Hospitalization

Sometimes it's best to be in a hospital when you stop taking pain medicine. You may have a short hospital stay if you:

• Have other conditions, such as depression or anxiety.
• Are taking high doses of medicines that have opiates or the sedative butalbital.
• Are using substances such as tranquilizers, opioids or barbiturates.

Preventive medicines

Preventive medicines may help you break the cycle of medication overuse headaches and ease the underlying headache condition, such as migraine. Work with your healthcare professional to keep from relapsing and to find a safer way to manage your headaches. During or after withdrawal, your healthcare professional may prescribe a daily medicine to prevent headaches such as:

• An anticonvulsant such as topiramate (Topamax, Qudexy XR, others).
• A tricyclic antidepressant such as amitriptyline or nortriptyline (Pamelor).
• A beta blocker such as propranolol (Inderal LA, Innopran XL, Hemangeol).
• A calcium channel blocker such as verapamil (Verelan, Verelan PM).

If you have a history of migraine, your healthcare professional might suggest a CGRP monoclonal antibody such as erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (Ajovy) or eptinezumab (Vyepti). People take erenumab, galcanezumab and fremanezumab as shots every month. People take eptinezumab through a vein every three months.

Injections

Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe.

Cognitive behavioral therapy, also called CBT

This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary.

Alternative medicine

For many people, complementary or alternative therapies offer relief from headache pain. But not all these therapies are backed by studies. Some therapies need more research. Discuss the pros and cons of complementary therapy with your healthcare professional.

Possible therapies include:

• Acupuncture. Acupuncture uses fine needles to put into the skin to release natural painkillers in the body. For some people, this therapy eases headaches.
• Biofeedback. Biofeedback teaches control of certain body responses that help ease pain. During biofeedback, you're connected to devices that keep track of those body responses. They give you feedback on your body, including muscle tension, heart rate and blood pressure. You then learn how to ease muscle tension and slow your heart rate and breathing. This helps you relax, which may help you cope with pain.
• Mindfulness. This is a type of meditation in which you focus on what you're sensing and feeling in the moment. Mindfulness involves the use of breathing methods and other ways to relax and lower stress. For some people, this practice may help ease headaches.

• Herbs, vitamins and minerals. Some dietary supplements seem to help prevent or treat certain types of headaches. They include magnesium, feverfew, coenzyme Q10 and riboflavin, also known as vitamin B-2. But there's little scientific support for these claims.

  If you want to try supplements, check with your healthcare professional. Some supplements may get in the way of other medicines you take. Or they may have other harmful effects.

Coping and support

It might help to talk to other people who've had medication overuse headaches. Ask your healthcare professional if there are support groups in your area. Or contact the National Headache Foundation at www.headaches.org or 888-643-5552.

Preparing for your appointment

You're likely to start by seeing your main healthcare professional. Your healthcare professional may send you to a doctor who specializes in nervous system disorders, called a neurologist.

Here's some information to help you get ready for your appointment.

What you can do

• Keep a headache diary. Write down your symptoms, even those that seem unrelated to headaches. Note what you did, ate or drank before the headache began. Also note how long the headache lasted. Include the medicines and amounts you took to treat the headache.
• Write down key personal information, including major stresses or recent life changes.
• List questions to ask your healthcare professional.

For medication overuse headaches, some questions to ask include:

• How does medicine I take to treat headaches cause headaches?
• Could there be other reasons for my headaches?
• How can I stop these headaches?
• If I keep getting headaches, how can I treat them?
• Are there brochures or other printed material I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional will ask questions about your headaches, such as when they started and what they feel like. Questions might include:

• What type of headache do you most often have?
• Have your headaches changed in the past six months?
• How bad are your symptoms?
• What headache medicines do you use, and how often?
• Have you increased the amount of headache medicines you take or how often you take them?
• What side effects have you had from medicines?
• Does anything make your symptoms better?
• What, if anything, makes your symptoms worse?

What you can do in the meantime

Until your appointment, take only as much of your medicine as often as your healthcare professional tells you to. And take care of yourself. Healthy lifestyle habits can help prevent headaches. Get enough sleep, eat plenty of fruits and vegetables, and get regular exercise. Stay away from known headache triggers.

A headache diary can help your healthcare professional. Keep track of when your headaches happen, how bad they are and how long they last. Also write down what you were doing when the headache began and what your response to the headache was.