Have You Ever Taken Too Much of Your Rescue Medication?

Woman suffering from migraine

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Yes, I have been under tremendous stress as of late and quickly attributed my daily migraine attacks to that. Each morning, for the last three weeks or so, I have awakened to the beginnings of an attack, the usual pain in the right side of my neck, either the beginning of one or the warning of one.

I’ve started with my Cefaly device and then have had to graduate through the day to more and more of my rescue drugs, sometimes (since I have to be so careful not to use up a month’s supply). A few times, I have just thrown everything I have at it in an attempt to completely break what I have seen as a daily cycle.

Yesterday, after not having been able to get to my physical therapist for some time, I called and was able to get an appointment. As soon as I told her my pattern, she prompted me to hop up on her table, saying, “I’d say you are suffering from 'rebound headache'"—which according to The American Migraine Foundation, is defined as, "a headache that is a secondary disorder caused by excessive use of acute medications. It has alternatively been referred to as a medication misuse headache."

Experts suspect that rebound headaches happen because of changes in how our body handles pain signals. Chronic pain changes how our bodies handle these signals, making it easier for those signals to happen or changing how we feel pain (it becomes more severe, or you feel pain from sensations that didn’t hurt previously).

Likewise, frequent pain medication use also changes how our bodies handle and process pain signals. It can mean you need higher doses of pain medications because you have developed a tolerance to medications, or our nervous system might generate or relay pain signals differently.

Why hadn’t I even considered this? I had suffered from this insidious pattern before. We get desperate for the pain to go away, need to keep going, keep functioning, and so, inadvertently, we make the situation far worse.

Interestingly, according to an article in Harvard Health Publishing, "the same pain-relieving medications taken for other conditions such as back pain, neck pain, or arthritis usually do not trigger medication overuse headache in people without a pre-existing primary headache disorder."

Risk factors for developing medication overuse headaches include:

• History of lifelong headaches. A history of lifelong headaches, especially migraines, puts us at risk.
• Regular use of headache medicines. Our risk increases if using a combination of painkillers, opioids, ergotamine, or triptans 10 or more days a month. Risk also increases if we use simple painkillers more than 15 days a month.

How Are Rebound Headaches Treated, and Is There a Cure?

Rebound headaches are very treatable. There isn’t a cure for them, but treatment can make them stop. Treatment involves the following:

• Stopping the medication(s) contributing to the rebound headaches is the most important part of treating rebound headaches, and the stoppage has to be total for this to work. With some medications, especially opioids or barbiturates, healthcare providers may slowly decrease the dose to prevent withdrawal.
• Alternate medications. Switching medications can help with the headache symptoms while we avoid taking the medication(s) that caused the rebound headaches. These are often called “bridge medications.” Bridge medications are medications that work differently from the one(s) that caused your rebound headaches. Onabotulinumtoxin A injections (commonly known as Botox), long-acting NSAIDs (such as naproxen), or antiseizure medications like topiramate are some of the most likely alternate treatments.

The above treatments sound practical, but having to stop taking medications that are usually our only hope for relief is very frightening and difficult. Nonetheless, knowing more about this serious and common problem with those suffering from chronic illness will force me to step back and assess what I’m taking, for how long I have been taking it, and call my neurologist for help instead of repeating what just doesn’t work and often worsens the overall attack. Hope you will, too!

“Not everything that is faced can be changed, but nothing can be changed until it is faced.” ―James Baldwin.