Treatments and drugs

By Mayo Clinic Staff

To break the cycle of rebound headaches, you'll need to restrict how much pain medication you use. Depending on what drug you've been taking, your doctor may recommend stopping the medication right away or gradually reducing the dose until you're taking the drug no more than twice a week, and possibly less if you're taking a medication that contains butalbital.

Breaking the cycle

Stopping pain medication isn't easy. Expect your headaches to get worse before they get better. Drug dependency may be a risk factor for any drug that results in rebound headaches, and you may experience withdrawal symptoms such as nervousness, restlessness, nausea, vomiting, insomnia or constipation. These symptoms generally last from two to 10 days, but they may persist for several weeks.

Your doctor may prescribe various treatments to help alleviate headache pain and the side effects associated with drug withdrawal. Dihydroergotamine (D.H.E. 45), an injectable ergot, helps relieve rebound-headache pain during the withdrawal process. D.H.E. 45 also can be used later on for the treatment of migraines, because it doesn't have the same risk of rebound headaches as other medications do. However, doctors may use other treatments instead of D.H.E., such as brief courses of corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs).

Hospitalization

Sometimes it's best to be in a controlled environment when you stop taking pain medication. A short hospital stay may be recommended if you:

  • Haven't been able to stop using pain medication on your own
  • Have other conditions, such as depression or anxiety
  • Are taking high doses of drugs that contain opiates or the sedative butalbital
  • Are abusing substances such as tranquilizers, opioids or barbiturates
  • Are experiencing prolonged, unrelenting headaches with other signs and symptoms, such as nausea and vomiting

Preventive medications

After you've broken the rebound-headache cycle, you and your doctor can find a safer way to manage your headaches. Before, during or after withdrawal, your doctor may prescribe any of the following daily preventive medication:

  • A tricyclic antidepressant such as amitriptyline or nortriptyline (Aventyl, Pamelor)
  • An anticonvulsant such as divalproex (Depakote, others), topiramate (Topamax) or gabapentin (Gralise, Neurontin)
  • A beta blocker such as propranolol (Inderal, InnoPran, others)
  • A calcium channel blocker, such as verapamil (Calan, Verelan, others)
  • Botulinum toxin type A (Botox)

These medications can help control your pain without risking another cycle of rebound headaches. If you're careful, you may be able to take a medication specifically meant for pain during future headache attacks. Be sure to take any medication exactly as prescribed.

Cognitive behavioral therapy (CBT)

During this talk therapy, you learn new or better ways to cope with your headaches. In CBT, you also work on healthy lifestyle habits and keeping a headache diary.

It's important to continue to work with your doctor after you've successfully withdrawn from your headache medications, because some people relapse and begin the rebound-headache cycle again.

Dec. 09, 2011