To break the cycle of rebound headaches, you'll need to restrict your pain medication. Depending on the drug you're taking, your doctor may recommend stopping the medication right away or gradually reducing the dose.
Breaking the cycle
When you stop your medication, expect your headaches to get worse before they get better. Drug dependency may be a risk factor for drugs that result in rebound headaches, and you may have withdrawal symptoms such as nervousness, restlessness, nausea, vomiting, insomnia or constipation. These symptoms generally last from two to 10 days, but they can persist for several weeks.
Your doctor may prescribe various treatments to help alleviate headache pain and the side effects associated with drug withdrawal. This is known as bridge or transitional therapy, and treatments may include nonsteroidal anti-inflammatory drugs, corticosteroids or dihydroergotamine, an ergot often given through a vein (intravenously).
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:
- Aren't 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
- Have limited or no family support
After you've broken the rebound-headache cycle, continue to work with your doctor to avoid relapsing and to find a safer way to manage your headaches. During or after withdrawal, your doctor may prescribe any of the following daily preventive medications:
- A tricyclic antidepressant such as amitriptyline or nortriptyline (Pamelor)
- An anticonvulsant such as divalproex (Depakote), topiramate (Topamax, Qudexy XR, Trokendi XR) or gabapentin (Gralise, Neurontin)
- A beta blocker such as propranolol (Inderal, Innopran XL)
- A calcium channel blocker, such as verapamil (Calan, Verelan, others)
These medications can help control your pain without risking 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 medications exactly as prescribed.
Cognitive behavioral therapy (CBT)
During this talk therapy, you learn ways to cope with your headaches. In CBT, you also work on healthy lifestyle habits and keeping a headache diary.
Dec. 02, 2014
- Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm. Accessed Oct. 6, 2014.
- Garza I, et al. Medication overuse headache: Treatment and prognosis. http://www.uptodate.com/home. Accessed Oct. 6, 2014.
- Garza I, et al. Medication overuse headache: Etiology, clinical features and diagnosis. http://www.uptodate.com/home. Accessed Oct. 6, 2014.
- Kristoffersen ES, et al. Medication overuse headache: Etiology, diagnosis and treatment. Therapeutic Advances in Drug Safety. 2014;5:87.
- Bajwa ZH, et al. Preventive treatment of migraine in adults. http://www.uptodate.com/home. Accessed Oct. 7, 2014.
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