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Rebound headaches are headaches that may be caused by
overusing pain medicines. Typically rebound headaches begin early in the
morning, however the location and severity of the headache can change on
a daily basis. Indeed, rebound headaches typically are daily occurrences
and can lead to problems involving anxiety, irritability, sleeplessness
and depression.
Migraine medications work to raise serotonin levels to ease pain, but when too
much medication is ingested something happens to the serotonin levels which causes
the chemical to lose its effectiveness. Research shows that serotonin levels are
lower when you take too much pain medication and then rise slightly after the
headaches get better and you stop taking the medication.
Either over-the-counter medication or prescription drugs can
lead to rebound headaches if taken too often or in greater amounts than
recommended. In addition to sedatives and tranquilizers, other
rebound-causing medications include:
• Caffeine-containing analgesics (Excedrin, Anacin, etc.) Caffeine is a primary
ingredient in many headache medicines. Although caffeine-based medication can relieve
migraine pain when temporarily, taking medicine containing caffeine
every day—as well as drinking caffeine-loaded beverages such as coffee
or soft drinks—can lead to more frequent and severe headaches. If the
headache worsens whenever you stop having caffeine, the caffeine may be
causing some of your headaches.
• Butalbital compounds (Fiorinal, Fioricet, Phrenilin, etc.)• Isometheptene
compounds (Midrin, Duradrin, etc.)• Decongestants (Sudafed, Tylenol Sinus, Dristan,
Afrin, etc.) • Ergotamines (Ergomar, Wigraine, Migranal and D.H.E. 45)• Triptans
(Imitrex, Amerge, Zomig, Maxalt and Axert)• Opioids and related drugs
(Tylenol with codeine, Percocet, Darvocet, OxyContin, etc.) Medications
that include any form of codeine, such as Tylenol 3, Vicodin and
Percocet, must be used with care because they can cause dependency
quickly.
If you experience any of the following symptoms, you may be suffering from rebound
headaches:
Your headache occurs daily or almost daily (three or four times a week).
You are considered a sufferer of a primary headache disorder and you use instant
prevention medication frequently and in large quantities.
Your headache deviates in strength, form, severity, and location on the head.
Even
the slightest physical movement or bare minimum of intellectual expenditure cause the
onset of the headache.
You have a lower than normal threshold for pain.
Your headache is accompanied by any of the these symptoms: nausea, restlessness,
anxiety, irritability, memory problems, difficulty in intellectual concentration,
depression.
You begin to notice evidence of an increasing tolerance to the effectiveness
of analgesics over a period of time.
You suffer withdrawal symptoms when you abruptly are taken off the medication.
You
notice a spontaneous improvement of headache pain when you discontinue the medications.
Should rebound migraines develop due to the overuse of medication, recovery cannot
be accomplished unless the sufferer ceases taking the drugs. On the other hand, should
it turn out that caffeine is causing the rebound, you may be able to get away with
merely reducing your intake instead of eliminating it altogether. Before
deciding on whether you want to stop gradually or abruptly, consider the
following:
Most headache drugs can be stopped suddenly, but make
sure you consult with a physician before withdrawal. Certain
non-headache medications, such as anti-anxiety drugs or beta-blockers,
require gradual withdrawal.
If you decide to go the route of gradually laying off standard headache medications,
withdrawal should be completed within three days or shorter. Any longer and discouragement
and impatience sets in.
Alternative medications may be administered during the first days. Examples of drugs
that may be used include dihydroergotamine (with or without metoclopramide), NSAIDs (in
mild cases), corticosteroids, or valproate.
Whichever method you decide to take when stopping your medication, expect a period of
worsening headache afterward. Most people feel better within two weeks,
although headache symptoms can persist for as long as four months and in
some rare cases even longer.
If the symptoms do not respond to treatment, or if they cause severe nausea and vomiting,
the patient may need to be hospitalized.
The good news is that many patients experience long-term relief from all headaches
afterward, and one study even concluded with over 80% of patients significantly improved
four months after withdrawal.
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