Headache Education Center

Medication overuse headache (rebound headache) with chronic migraine and/or chronic tension-type headache


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Description


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Patients that have a prior or current history of headaches such as migraine or tension-type headaches tend to be much more susceptible to developing medication overuse headache (rebound headache). Medication overuse headache is one of the most common causes of chronic daily headache (more than 15 days of headache per month) in the form of chronic migraine or chronic tension-type headache. This factor must be eliminated if present, and the headaches will never improve until a weaning detoxification from the overused medications happens. It can take 2-3 months for significant improvement to occur following detoxification, depending on medicine used, duration of use, frequency of use, and quantity of use. Preventive (daily medicines used to lessen the frequency and/or severity of headaches) and abortive (“as-needed” at headache onset) pain medications are also generally less effective in the setting of medication overuse headache. The overused medications are often taken for the headaches. However, these medicines are also commonly being used for some other type of body pain such as back pain, but inadvertently convert an infrequent headache to a frequent or daily headache. This is almost a guarantee to happen if there is a history of migraine headaches.

As discussed above, overuse of certain medications will typically convert underlying episodic migraine to chronic migraine over time. Research has shown that medication overuse can transform episodic migraine (less than 15 days of headache per month) to chronic migraine (greater than 15 days of headache per month) if the following medications are used at the following frequencies:

  1. 10 or more days per month for at least 2-3 consecutive months of over the counter (OTC) pain medications (Tylenol, Excedrin, Acetaminophen, Aleve, Naproxen, Motrin, Advil, Ibuprofen, or other non-steroidal anti-inflammatories (NSAIDs))
  2. 10 or more days per month for at least 2-3 consecutive months of triptans (Sumatriptan, Rizatriptan, Zolmitriptan, Almotriptan, Frovatriptan, Naratriptan, Eletriptan)
  3. 8 or more days per month for at least 2-3 months of any narcotic, opioid, or opiate medication (Vicodin, Norco, Hydrocodone, Oxycodone, Oxycontin, Percocet, Tramadol, Ultram, Ultracet, Morphine, Codeine)
  4. 5 or more days per month for at least 2-3 months of any butalbital containing medication (Fioricet, Fiorinal, Esgic)