Migraines, both common and with aura, are treated with pain relievers that can lead to a vicious cycle of headaches caused by the pain killers used to treat them. These are variously named rebound headaches, medication-induced headaches and medication-overuse headaches, depending on which expert is discussing the problem.
"The pain medication shrinks your blood vessels, so the headache pain stops. But when the medicine wears off, the vessels expand and give you a headache, causing another headache. Careful comparison of signs and symptoms often shows that th. In response, you take more medicine.'" ( Bernstein p. 33) But it is not a true migraine headache: It is not all on one side of the head, there is no hypersensitivity to light or sound, and there is no gastric upset.
The Lazy Brain
In a way, the brain has got lazy and now requires a certain level of medication to function without pain. Worse, it soon needs to have the level of medication increased.
This type of dependency is neither a moral nor a psychological issue. It is a pain issue. But once the body has gotten used to having a drug, it will not voluntarily give it up. It wants more of the wonderful relief that a lack of pain brings – that sense of being lighter and able to think again.
Recognizing the Rebound Headache
Soon, a sense of anxiety or unease arises and the patient thinks, "Darn, another headache is going to start soon, I'd better take something to head it off." This anxiety is the warning sign.
"Heading off" or "taking the edge off" pain can mean it is time to cut back on the usual treatments and let the brain get back on its own track. This can be achieved by treating the rebound headache with a different pain reliever (eg: ASA instead of ibuprofen) and by gradually taking smaller doses of what works, usually over the course of a day or two. Instead of Tylenol 2, try ASA with codeine (legal to buy over the counter in some countries), or take one tablet instead of two. Your doctor should know what is happening – don't leave him in the dark, as he may know a better or easier way. The goal is to be taking no medication for a few days, until the next migraine starts.
Distraction is the friend of anyone in this condition. Take the minimum to get the pain under control, then go for a walk, read a book, call a friend – anything to get your mind off your headache.
It may be tempting to be "brave" and stop all at once. But this will worsen the headache and most likely trigger another migraine. A migraineur's brain and body are extremely sensitive to stimuli, and reducing medications should be gradual, and under a doctor's guidance if possible. Sometimes intractible headaches require admittance in a hospital or treatment facility to get them under control and gradually withdraw the medication that is contributing to the headaches.
How Soon Can Overuse Headaches Start?
Some doctors believe that taking pain relievers even just two or three days in a row is enough to create a dependency in the brain. However, this does not take into account the fact that a migraine can last two or three days, (occasionally more) and that the migraine must be treated. It takes time to learn individual reactions to pain relievers and time to learn signs and symptoms, and time to figure out when the migraine has gone and the rebound has started. Few people keep taking pain relievers just for the fun of it. Tracking may be time consuming, but not as time and energy-consuming as a migraine.
Suffering a day of mild anxiety by reducing or eliminating pain medications, can prevent further headache pain.
Sources: Bernstein, Carolyn, M D, The Migraine Brain, Free Press, 2009
Cowan, Robert, M D, The Keeler Migraine Method, Penguin, 2008
Geraldine Ketchum - Geraldine Ketchum is a librarian living in Southwestern Ontario. With a degree in English Language and Lit from UWO, she went straight on ...
Join the Conversation