If you’ve been suffering with headaches and have been treating these with analgesics (pain medications) more than 2 or 3 days out of each week, you may have developed a phenomenon known as Rebound Headaches. “Analgesic” rebound headaches are real headaches that may mimic your other headaches. They usually occur daily, as well as they may mask your underlying headache disorder. (People who are most susceptible to this phenomenon are those who have migraines, a.k.a. migraineurs). Analgesics are very good painkillers if used in moderation. However, with too frequent usage, they can actually begin to cause the pain they aim to alleviate. Treatment is time-consuming and takes much self-control, compliance and determination on the part of the patient.

Headache specialists have determined that any painkiller taken too often could actually cause these headaches to develop. Examples of such analgesics are: Any over the counter pain relievers (Excedrin, Tylenol, Naprosyn, Advil, Aleve, Ibuprofen, etc.); Prescription anti-inflammatory drugs or NSAIDS (Anaprox DS, Indocin, etc.); Narcotics (Percocet, Vicodin, Codeine, etc.); Migraine medications or triptans (Imitrex, Zomig, Axert, Maxalt, Amerge, Frova, Relpax). The triptan medications are less likely to cause this rebound effect, but they still must be taken in limited quantities over time.

With regard to treatment, the most important point to remember is that rebound headaches will not just stop if replaced with another pain medication, nor will they end if one just stops the offending medication. The painkiller(s) causing this condition must be eliminated, without substituting a similar replacement, in order to allow the body to reset. Unfortunately, this is a very time-consuming process. Some people will improve and return to their prior headache pattern after about 2 wks, but others may take many months to return to their “baseline”. This is entirely dependent on the individual makeup and how long he or she has been in the current rebound state. An important note is that once these medications are stopped, headaches tend to increase during this phase because the body is missing it. Again, in order for someone to make it through this potentially unpleasant phase, he or she must have patience.

For clarity’s sake, here’s a way to think of how one may develop rebound headaches: Many people drink morning coffee/tea to start their day. If they are unable to obtain this beverage, for whatever reason, likely they’ll develop a headache. Their solution is to grab a cup of coffee/tea and it will often abort their headache. This could be called caffeine withdrawal or a rebound headache state from the daily consumption of this caffeine.

Mark W. Green, MD
Anne Helena Remmes, MD
Carolyn Barley Britton, MD
Lynda J. Krasenbaum, MSN, CS, ARNP