Medication Overuse Headache – Symptoms and Causes
Overview
Medication overuse headaches happen when people take headache medicines too often. Taking pain pills a few times is fine, but using them more than two days each week can lead to more headaches instead of relief.
This problem mainly affects people who already have headache conditions like migraines. Those with a history of headaches who regularly take pain medicine for other health issues, such as arthritis, may also experience these rebound headaches.
The good news is that medication overuse headaches typically go away once a person stops taking the pain medicine. However, this creates a challenge: how to manage pain during the withdrawal period.
It’s important to work with a healthcare professional rather than stopping medicines suddenly. They can create a personalized plan to break the cycle of medication overuse while still addressing your pain needs.
Symptoms of Medication Overuse Headaches
People with medication overuse headaches often notice certain patterns. These headaches typically occur daily or almost every day and may even wake you from sleep.
A key sign is that the headache improves after taking pain medicine but returns when the medicine wears off. This creates a cycle of needing more medication.
Other common symptoms include:
- Feeling sick to your stomach
- Being restless or unable to relax
- Having trouble focusing
- Experiencing memory issues
- Feeling irritable or easily annoyed
When Medical Help Is Needed
Some headaches are normal, but certain warning signs should not be ignored. Seek emergency care right away if your headache:
- Comes on suddenly and is extremely painful
- Appears with fever, stiff neck, confusion, or vision problems
- Happens after hitting your head
- Gets worse despite rest and medicine
- Is a new type that persists, especially if you’re over 50
- Makes it hard to breathe
- Only hurts when you’re sitting or standing up
Contact your healthcare provider if:
- You have headaches more than twice weekly
- You use pain relievers for headaches more than twice a week
- You need larger doses of over-the-counter medicines for relief
- Your usual headache pattern changes
Causes
The exact reasons for medication overuse headaches remain unclear to healthcare professionals. Different medications carry varying levels of risk for developing these headaches.
Most headache medications can potentially trigger medication overuse headaches, including:
Simple Pain Relievers (Low Risk)
- Acetaminophen (Tylenol)
- Ibuprofen (Advil, Motrin IB)
- Naproxen sodium (Aleve)
Taking more than the recommended daily amount increases the risk significantly.
Combined Pain Relievers (Moderate to High Risk)
- Over-the-counter combinations with caffeine, aspirin, and acetaminophen (Excedrin)
- Prescription medications containing butalbital (Butapap, Lanorinal)
Butalbital-containing medications pose a high risk and are generally not recommended for headache treatment.
Migraine Medications
- Triptans (Imitrex, Zomig) carry a high risk
- Dihydroergotamine (Migranal, Trudhesa) appears to have a lower risk
- Gepants (newer medications) including ubrogepant, rimegepant, and zavegepant don’t seem to cause medication overuse headaches
Opioids (High Risk)
- These include oxycodone, hydrocodone, tramadol, and codeine-acetaminophen combinations
- Using these just 10 or more days monthly can lead to medication overuse headaches
The risk factors depend on both the type of medication and frequency of use. Even medications considered safer can cause problems when taken too often or in excessive amounts.
Risk Factors
People with certain traits face higher chances of getting medication overuse headaches:
- Long-Term Headache History – Those who have suffered from headaches, particularly migraines, for many years are more likely to develop this condition. When existing headaches aren’t properly managed, overuse problems can develop and make treatment harder.
Regular Pain Medication Use: Using combination painkillers, opioids, ergotamine, or triptans for 10 or more days monthly increases risk. Simple painkillers used more than 15 days each month also raise concerns, especially when this pattern continues for three months or longer.
Substance Use History: People with a past history of alcohol use disorders or other substance dependencies have a higher chance of developing medication overuse headaches.
Prevention
Preventing medication overuse headaches requires careful management of headache medicines and healthy lifestyle habits.
Managing Medication Use
Follow these guidelines to avoid medication overuse:
- Take headache medicine exactly as prescribed by your doctor
- Contact your healthcare provider if you need headache medication more than twice weekly
- Avoid medications containing butalbital or opioids when possible
- Use over-the-counter pain relievers less than 14 days per month
- Limit triptans or combination pain relievers to fewer than 10 days monthly
Identifying Triggers
Keep a headache diary to track potential triggers. Record details about each headache, including:
| Information to Track | Examples |
|---|---|
| Time and date | Monday, 10:30 AM |
| Duration | 4 hours |
| Pain location | Behind right eye |
| Pain intensity (1-10) | 7/10 |
| Possible triggers | Skipped lunch, stressful meeting |
| Medications taken | Name, dosage, effectiveness |
Healthy Lifestyle Practices
Sleep Habits
Maintain consistent sleep patterns by going to bed and waking up at the same times daily, even on weekends.
Eating Patterns
Don’t skip meals. Start with a nutritious breakfast and eat lunch and dinner at regular times each day.
Hydration
Drink plenty of water throughout the day. Avoid beverages with caffeine, which can trigger headaches.
Physical Activity
Exercise regularly with activities you enjoy. Physical activity releases chemicals that block pain signals to your brain. Always check with your doctor before starting a new exercise program.
Stress Management
Reduce stress by:
- Simplifying your schedule
- Planning your day ahead of time
- Practicing positive thinking
- Using relaxation techniques like deep breathing or meditation
Weight Management
If needed, work with your healthcare provider to develop a weight management plan, as obesity can contribute to headaches.
Quit Smoking
If you smoke, talk to your doctor about cessation strategies. Smoking increases the risk of medication overuse headaches.
Caffeine Reduction
Monitor your caffeine intake from all sources:
- Coffee and tea
- Sodas and energy drinks
- Some pain relievers
- Chocolate and other foods
Read product labels carefully to track your total caffeine consumption, as daily caffeine use may contribute to medication overuse headaches.
