Your doctor can usually diagnose medication overuse headaches based on a history of chronic headaches and frequent use of medication. Testing usually isn't necessary.
To break the cycle of medication overuse 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 medication overuse headaches, and you may have withdrawal symptoms such as:
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. Treatments may include nonsteroidal anti-inflammatory drugs, corticosteroids or dihydroergotamine, an ergot that may be given through a vein (intravenously).
There's debate over how much benefit bridge therapy may offer, and whether or not one drug is more effective than others. Withdrawal headaches tend to improve in less than a week.
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:
- 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
Preventive medications may help you break the cycle of medication overuse headaches. 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:
- An anticonvulsant such as topiramate (Topamax, Qudexy XR, Trokendi XR)
- A tricyclic antidepressant such as amitriptyline or nortriptyline (Pamelor)
- 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 medication overuse 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.
Injections of onabotulinumtoxinA (Botox) may help reduce the number of headaches experienced per month as well as headache severity.
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.
For many people, complementary or alternative therapies offer relief from headache pain. However, not all complementary or alternative therapies have been studied as headache treatments, and others need further research. Discuss the risks and benefits of complementary therapy with your doctor.
Possible therapies include:
- Acupuncture. This ancient technique uses fine needles to promote the release of natural painkillers and other chemicals in the central nervous system. This therapy may ease headaches.
- Biofeedback. Biofeedback teaches you to control certain body responses that help reduce pain. During a session, you're connected to devices that monitor and give you feedback on body functions, such as muscle tension, heart rate and blood pressure. You then learn how to reduce muscle tension and slow your heart rate and breathing to help you relax, which may help you cope with pain.
- Herbs, vitamins and minerals. Some dietary supplements — including magnesium, riboflavin (vitamin B2), feverfew and coenzyme Q10 — seem to help prevent or treat some types of headaches, but there's little scientific support for these claims. If you're considering using supplements, check with your doctor. Some supplements may interfere with other drugs you take or have other harmful effects.
Coping and support
You may find it helpful to talk to other people who've been through the same experience you're having. Ask your doctor if there are support groups in your area, or contact the National Headache Foundation at www.headaches.org or 888-643-5552.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. You may then be referred to a doctor who specializes in nervous system disorders (neurologist).
Here's some information to help you get ready for your appointment.
What you can do
- Keep a headache diary. Write down your symptoms, even those that seem unrelated to headaches. Note what you were doing, eating or drinking before the headache began, how long the headache lasted, and the medications and amounts you took to treat the headache.
- Write down key personal information, including major stresses or recent life changes.
- List questions to ask your doctor.
For medication overuse headaches, some questions to ask your doctor include:
- How could I cause a headache with medicine I took to treat a headache?
- Could there be other reasons for my headaches?
- How can I stop these headaches?
- Are there alternatives to the approach you're suggesting?
- If my original headaches return, how can I treat them?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask any other questions.
What to expect from your doctor
The doctor will ask questions about your headaches, such as when they started and what they feel like. The more the doctor knows about your headaches and medication use, the better care he or she will be able to provide. Your doctor may ask:
- What type of headache do you usually have?
- Have your headaches changed in the past six months?
- How severe are your symptoms?
- What headache medications do you use, and how often?
- Have you increased the amount or frequency of taking them?
- What side effects have you had from medications?
- Does anything help improve your symptoms?
- What, if anything, appears to worsen your symptoms?
What you can do in the meantime
Until your appointment, take your medication only as directed by your doctor, and take care of yourself. Healthy lifestyle habits — such as getting adequate sleep, eating plenty of fruits and vegetables, and getting regular exercise — can help prevent headaches. Avoid any known headache triggers.
A headache diary can be very helpful for your doctor. Keep track of when your headaches occur, their severity and duration, what you were doing when the headache began, and what your response to the headache was.
Nov. 29, 2018