Rebound Headaches

Rebound Headaches

We noticed that a lot of people are suffering from rebound headaches and Sara asked me to post some information. I hope this is helpful or generates some ideas. If you have questions, please feel free to ask publicly or via my email (left button under my name).

 

Rebound headaches occur from over-using medications for headache pain. Generally they involve exceeding labelling instructions or doctor's prescriptions advice. (Migraine Headaches, Glossary of Terms, WebMD, http://my.webmd.com/content/article/46/1826_50702.htm)

 

Initially the medication relieves the headache but after continuous use, a headache starts when the medication wears off and is relieved when the medication is taken again because the body has become accustomed to it. Over time more and more medication is needed.

 

For more information there is a good article on the Healing Well Website titled “Rebound Headache Cycle:  What Is It and How to Break It” at http://www.healingwell.com/library/migraines/jolly1.asp.

 

A rebound headache often feels to me like a tension headache but left long enough can trigger a migraine headache. Mine are often triggered from lack of caffeine, codeine or Tylenol. Other pain relievers such as Ibuprofen and triptans such as Zomig and Amerge can also cause rebound headaches.

 

There are many different schools of thought on coming off medications causing rebound medications. I have read books written by neurologists that say one should stop them completely and endure the pain. I have never been able to do this. I find the best way is to wean off the medication(s) slowly. For example, I started at 4 Tylenol 3s / day, one in the morning, one at noon and one at bed time. Then in one week 3 / day ½ in the morning, one at noon and one at bed time, decreasing each week by ½. I experienced some pain but overall it was bearable.

 

I take Toradol, a prescription pain killer my doctor feels does not contribute to rebound headaches. I also take Topamax, Nadolol and Celexa as preventative medications with some natural supplements: Calcium / Magnesium, Valerian Root, Multivitamin and Melatonin. As I wean off the medications I find that these medications work better.

 

For more information there is a good article on the Healing Well Website title “Rebound Headache Cycle:  How to Safely Taper off Medications” at http://www.healingwell.com/library/migraines/jolly2.asp.

 

 

I have found the secret / trick is to have a plan. Write out how you’re going to come off the medications, get your doctor’s approval and then work at it day by day. If the pain becomes unbearable go to the doctor. Include in your plan strategies for the days when you’re going to have a headache. Things like hot baths, alternative medications, exercise, meditation, walking or other calming activities.

 

Once you have weaned off the medications follow the 2 and 5 rule. If you take medication 2 days in a row don’t take it again for 5. This should help you avoid the rebound rut.

 

 

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Nicky

 Nicky....

Hi Sara,

Thanks!

You're right they can be worse than migraines. I find that the constant pain can be enough to drive you insane. Nothing seems to work to fix them and they persist. It does take a lot of will power. For me the significant pain is usually the motivation I need.

It's interesting that you mentioned your kidney stones. I think a lot of us have migraines in addition to another illness and can develop rebound headaches in reaction to medication we're taking for that illness or from pain from that illness.

Exactly-

In my case, the kidney problems were so bad that I could not avoid the rebound issues...I had to take the pain medication to get through the kidney stuff and then deal with the rebound headache things later...

Kind of a catch 22

rebound

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Sara-Migraine/Headache Forum Moderator

Bump for Laura

Hi Nicky and Sara,
Maybe you (or other members) can enlighten me. First thank you very much for posting the rebound HA articles. I have read them and, while I understand the concept and the "2 on 5 off" specifics, this is what I don't understand. For those of us who have frequent (i.e., 4-6 a week) migraines, what exactly are we supposed to do on those 5 "off" days? Odds are we are going to have headaches on those days, and if we have followed the rebound advice and the headaches we are having are not rebound headaches but rather good (bad) old migraines.....then what? We just try to use ice packs and tolerate the pain until the 2 "analgesics allowed" days roll around? I am just trying to understand how to incorporate the rebound info into a headache treatment strategy. Does everyone (with frequent migraines) just have to suffer for 5 days and then take their meds for 2 days? Or would, say, something like prochlorperazine (Compazine) which is technically not an analgesic be allowed during those intervening 5 days? Just wondering if there is any way to construct a treatment plan that avoids analgesics for 5 days yet still provides relief....Perhaps my new neurologist tomorrow will have some bright ideas....(no guarantees there....) Do you guys know of any?
Laura

Hi Laura,

That's the key, how do you live with that schedule? I think the answer is complex. It's a combination of preventative medications, lifestyle change and education.

It starts with you identifying the triggers that bring on migraines and avoiding them. For me yeast is a trigger and I go out of my way to avoid it, reading labels, not eating bread, not risking it at all. Other foods that trigger my headaches are alcohol, chocolate, msg, aged cheese, grapes, bacon, onions, mushrooms, coffee to name a few. I don't eat these foods and I don't drink alcohol any more. It's just not worth it.

Exercise also plays a big role. I hate exercise and find that it often triggers headaches. BUT once I do it on a regular basis the headaches lessen and they occur less frequently so I do my best to exercise regularly.

I worked with my neurologist to find preventative medications that reduce the severity and frequency of my migraines. I take a beta-blocker that reduces the severity of my migraines and I'm taking topamax that reduces the frequency. I'm also taking MigraHealth (supplement made up of Magnesium, B2, Feverfew) that also helps prevent migraines).

So I do my best to reduce the frequency of my migraines. In situations when I do have a migraine or just a headache for more than a few days I start with my triptan medications, then try Toradol or Aleve depending on the severity and then a narcotic (Tylenol 3). Once the headache has gone past 2 days I stick with Toradol and Aleve which my doctor tells me are not as likely to cause rebound headaches.

I liked your suggestions in another message about switching around your medications. Now that I have weaned off Tylenol 3s I find that for a 1 -2 headache Extra Strength Tylenol will work. So perhaps using that for a couple of days, then Aleve for a couple of days and then perhaps Toradol.

I have also given up the idea of having to complete wipe out the headache. If I can get it to a manageable level then I try other things, relaxation, warm baths, and walking. Sometimes I will take something like Gravol (Dramamine in the US) with whatever medication I am taking which settles my stomach and lets me sleep and relax so the pain medication can work.

I've not completely figured it out. I'm still reading a lot and asking a lot of questions of my neurologist to educate myself so that I can do my best to avoid rebound headaches and decrease frequency of my migraines. I still get about 11 a month and last month have had a regular headache the other 20 days.  

Hope this helps.

Another thing is to switch up....

I am sorry for you. I am new to this.
It is all just so crazy. To live like this. Ijust wanted to mention that I have had to go on Steriods a few times before to "break" a migraine cycle. It does help a great deal. I have had migraines now for over 18 years and never heard of rebound until this year. That is the headache after the headache, right? Wow, and all this time I thought that it was just my head getting ready to explode again.
With me I now get migraines 2or 3 a month but they last from 5-7 days each one, where even earlier this year I would get 7-10 a month and they would only last a day or two. I can not even think at all anymore also my face is completly numb almost all the time with or with out the pain. My life is going by me and my head head hurts too bad to even watch.
My med list now: Depakote 500mg daily, Immatrex as needed, Codeine 30mg as needed, Pheneragran 25mg as needed. (I carry them with me everywhere I go now) I have tried almost everything. All test "look" good, whats next? How do you live like this? Even when you are not in pain the FEAR of the pain is always there. Any advice would be helpful. Thank you all, Cheri