Migralex Blog

Medication overuse or “rebound” headaches

People who take medications with caffeine or narcotic drugs, such as Excedrin, Fioricet, Esgic, codeine, Vicodin, or Percocet, for their headaches on more than one or two days a week are at risk of making their headaches worse.

Dietary caffeine alone can cause rebound or medication overuse headaches. They are called rebound headaches because pain at first gets better, but then rebounds and gets worse. Many patients who come to see me feel that these drugs help and no other medicine works as well. My question to them is, if this medicine helps than why are you coming to see me. Well, they answer, the medicine works less and less and I have to take more and more of it.

When these medications or caffeine are consumed frequently, the brain gradually gets used to their effects and ever increasing amounts are needed to produce the same effect. With escalation of the dose not only headaches get worse, but other side effects also appear. Stopping these medications causes temporary worsening of headaches. To cope with this worsening and other withdrawal symptoms, headache specialist will usually prescribe a combination of treatments. These may include anti-inflammatory pain killers, magnesium infusion, steroid medication, Botox injections, preventive drugs, and relaxation training.

Ideally, of course, people should avoid taking these medications in the first place, or at least limit their use to 4-5 days a month.

Researchers in Thailand seem to have discovered a brain receptor which may be responsible for medication overuse headaches. They exposed rats to acetaminophen (Tylenol) and found that their brains were more irritable and more likely to develop what is called cortical spreading depression – a phenomenon thought to underlie headaches in humans as well. These rats were also found to have an increased number of 5HT2A serotonin receptors which are involved in pain mechanisms in the brain.

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