Medication overuse headaches

Overview

Medication overuse headaches are the result of the long-term use of medicines needed to treat headaches such as migraines. It's OK to take pain relievers for headaches sometimes. But people who take them more than a couple of days a week may get medication overuse headaches, also called rebound headaches.

For people with a headache condition such as migraine, most medicines for pain relief can have this effect. This doesn't seem true for people who have never had a headache condition. But people with a history of headaches who take pain relievers regularly for another condition, such as arthritis, may get medicine overuse headaches.

Medication overuse headaches most often go away after stopping the pain medicine. This can make it challenging to manage pain in the short term. But your healthcare professional can help you find ways to prevent medication overuse headaches.

Symptoms

Symptoms of medication overuse headaches depend on the type of headache being treated and the medicine used. Medication overuse headaches tend to:

• Happen every day or nearly every day. These headaches often wake people from sleep.
• Improve with pain medicine but then return as the medicine wears off.

Other symptoms may include:

• Nausea.
• Restlessness.
• Trouble concentrating.
• Memory problems.
• Irritability.

When to see a doctor

It's common to have some headaches. But take headaches seriously. Some types of headaches can be life-threatening.

Seek immediate medical care if your headache:

• Is sudden and very bad.
• Happens with a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or trouble speaking.
• Follows a head injury.
• Gets worse even with rest and pain medicine.
• Is a new type of headache that's lasting, especially in people older than 50.
• Happens with shortness of breath.
• Happens when upright but goes away when lying flat.

Talk with your healthcare professional if:

• You have two or more headaches a week.
• You take a pain reliever for your headaches more than twice a week.
• You need more than the dose you're supposed to take of pain medicines you get without a prescription to relieve your headaches.
• Your headache pattern changes.

Causes

Experts don't know exactly why medication overuse headaches happen. The risk of getting these headaches varies depending on the medicine. But most headache medicines can lead to medication overuse headaches, including:

• Simple pain relievers. Common pain relievers such as acetaminophen (Tylenol, others), (Advil, Motrin IB, others) and naproxen sodium (Aleve) have a low risk of causing medication overuse headaches. Taking more than the daily dosages raises the risk.

• Combined pain relievers. Pain relievers you can buy at the store that combine caffeine, aspirin and acetaminophen (Excedrin) have a moderate risk of causing medication overuse headaches.

  This group also includes combined prescription medicines that have the sedative butalbital (Butapap, Lanorinal, others). Medicines with butalbital have a high risk of causing medication overuse headaches. It's best not to take them to treat headaches.

• Migraine medicines. Triptans (Imitrex, Zomig, others) used to treat migraine have a high risk of medication overuse headaches. The ergot dihydroergotamine (Migranal, Trudhesa) appears to have a lower risk of causing medication overuse headaches.

  A newer group of migraine medicines known as gepants don't seem to cause medication overuse headaches. Gepants include ubrogepant (Ubrelvy), rimegepant (Nurtec ODT) and zavegepant (Zavzpret).

• Opioids. Painkillers made from opium or from human-made opium compounds have a high risk of causing medication overuse headaches. They include oxycodone (Oxycontin, Roxicodone, others) hydrocodone, tramadol (Conzip, Qdolo, others), and combined codeine and acetaminophen. Taking them 10 or more days a month can lead to medication overuse headaches.

Risk factors

Risk factors for getting medication overuse headaches include:

• Long-term history of headaches. A long-term history of headaches, especially migraines, raises the risk. Medication overuse headache often occurs when a headache condition such as migraine is not well controlled and may make the underlying headache condition difficult to treat.
• Regular use of headache medicines. Your risk goes up if you use combined painkillers, opioids, ergotamine or triptans 10 or more days a month. Risk also rises if you use simple painkillers more than 15 days a month. This is especially true if you use these medicines for three months or longer.
• History of substance use disorders. A history of alcohol use disorder or another substance use disorder puts you at risk.

Prevention

To help prevent medication overuse headaches:

• Take your headache medicine as prescribed.
• Contact your healthcare professional if you need headache medicine more than twice a week.
• Don't take medicines that have butalbital or opioids if possible.
• Use painkillers you can get without a prescription fewer than 14 days a month.
• Limit use of triptans or combined pain relievers to no more than nine days a month.

Taking care of yourself can help prevent most headaches.

• Stay away from headache triggers. If you're not sure what triggers your headaches, keep a headache diary. Write down details about every headache. You may see a pattern.
• Get enough sleep. Go to bed and wake up at the same time every day, even on weekends.
• Don't skip meals. Start your day with a healthy breakfast. Eat lunch and dinner at about the same time every day.
• Stay hydrated. Be sure to drink plenty of water or other fluids that don't have caffeine.
• Exercise regularly. Physical activity causes the body to release chemicals that block pain signals to the brain. With your healthcare professional's OK, choose activities you enjoy. You might walk, swim or cycle.
• Lower stress. Make your schedule simpler. Plan your day. Try to stay positive.
• Lose weight. Obesity can add to headaches. If you need to lose weight, ask your healthcare professional to help you find a program that works for you.
• Quit smoking. If you smoke, talk to your healthcare professional about quitting. Smoking is linked to a higher risk of medication overuse headaches.
• Limit caffeine. Daily doses of caffeine also may add to medication overuse headaches. Caffeine may come from coffee, soda, pain relievers and other products. Read product labels to make sure you're not getting more caffeine than you know about.