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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 of medication overuse headaches depend on the type of headache being treated and the medicine used. Medication overuse headaches tend to:
Other symptoms may include:
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:
Talk with your healthcare professional if:
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:
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).
Risk factors for getting medication overuse headaches include:
To help prevent medication overuse headaches:
Taking care of yourself can help prevent most headaches.
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.
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.
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:
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.
Sometimes it's best to be in a hospital when you stop taking pain medicine. You may have a short hospital stay if you:
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:
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.
Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe.
This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary.
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:
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.
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.
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.
For medication overuse headaches, some questions to ask include:
Be sure to ask all the questions you have.
Your healthcare professional will ask questions about your headaches, such as when they started and what they feel like. Questions might include:
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.