Treating rebound headaches

Some of the medications used for headaches, taken in large amounts, can actually increase the frequency of headaches, resulting in the transformation of episodic headaches to chronic ones; these are sometimes called "rebound" headaches. They are similar to, but less severe than, those for which the medication was taken. The rebound headaches may last for days. The mechanisms are not fully understood. Medication overuse is most likely to occur in patients with chronic tension headaches.

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Commonly used medications that can bring on rebound headaches include many medications usually thought of as safe, including aspirin, sinus relief medications, acetaminophen, ibuprofen, sedatives for sleep, ergotamine preparations, codeine and related narcotic preparations, and over-the-counter combination headache remedies. Continued use of these medications may eventually lead to the development of low-grade headaches that just will not go away. Some people who never knowingly suffered from headaches can develop chronic daily headaches by overusing analgesics for other problems.

When these chronic daily headaches occur, many patients react by taking larger or more frequent doses of the medication. But that not only exposes the patient to a higher level of the medication's toxicity but also makes the situation worse. Patients may find themselves taking the medication constantly for months because they continue to find short-term relief, although the headache inevitably returns. The medication may wear off during sleep, waking the patient in the middle of the night with a new headache.

Usually, discontinuing the medication will bring back headaches that can be controlled with carefully administered pain relievers. Patients taking large doses of sedative hypnotics, sedative-containing combination headache pills, or narcotics may need to be admitted to the hospital so they can recover under supervision.