Medicine Overuse Headache

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KEY POINTS

• A medicine overuse headache (MOH) happens several times a week while you are being treated for another headache condition.
• Frequent headaches cause you to take pain medicines for more than 10 to 15 days every month, but as soon as the medicine wears off, the headache comes back. Taking the pain medicine so often makes the headaches happen more often instead of making them better.
• Treatment includes stopping the pain medicine until the headaches decrease, and may include counseling, biofeedback, or physical therapy.
• If you find that you are taking medicine for headaches often, it is important that you talk to your healthcare provider.

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What is a medicine overuse headache?

A medicine overuse headache (MOH) happens several times a week while you are being treated for another headache condition. Frequent headaches cause you to take pain medicines for more than 10 to 15 days every month, but as soon as the medicine wears off, the headache comes back. Taking the pain medicine so often makes the headaches happen more often instead of making them better.

MOH may also be called a rebound headache.

What is the cause?

People who have migraine headaches or tension headaches are most likely to have MOH. The medicines that are most likely to lead to MOH include:

• Narcotic pain medicines such as butorphanol or codeine
• Combination products that contain butalbital
• Triptan medicines such as frovatriptan or sumatriptan
• Aspirin/acetaminophen/caffeine combination medicines
• Ergotamine (not dihydroergotamine, or D.H.E.)

Nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen and naproxen are less likely to cause MOH unless you take them more than 15 days per month.

What are the symptoms?

Symptoms may include headaches that:

• Often wake you early in the morning and last all day
• Improve with pain medicine but then come back when the medicine wears off
• Get worse with physical activity or concentrating

Other symptoms may include:

• Nausea
• Anxiety and restlessness
• Memory problems
• Irritability
• Depression

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. There are no lab tests or X-rays for diagnosing MOH. You may have tests or scans to check for other possible causes of the symptoms.

It will help if you keep a record of:

• Date and time of each attack
• Type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
• Location of pain
• What medicine you took
• How long each headache lasted

How is it treated?

Your healthcare provider will tell you to avoid using certain pain medicines until you have gone for at least 6 days without a headache. Depending on the medicine you have been taking, you may have withdrawal symptoms such as:

• Worse headaches
• Nausea and vomiting
• Restlessness, nervousness, and trouble sleeping

Withdrawal symptoms usually last 2 to 10 days, but may last as long as 4 weeks. If withdrawal symptoms are severe, you may be prescribed medicines to decrease pain, nausea, and tense muscles.

Your provider may also recommend:

• Physical therapy
• Biofeedback therapy, which uses a machine to help you learn to control muscle rebound
• Counseling

If you start taking the same pain medicines again, you need to limit them to 2 days per week. If you take the medicines more often, you are at risk for daily headaches.

Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:

• What to do when you have a headache
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests. Contact your healthcare provider if you have new or worsening symptoms.

How can I help prevent medicine overuse headaches?

A healthy lifestyle may help:

• Eat a healthy diet. Don’t skip meals.
• Stay fit with the right kind of exercise for you.
• Limit caffeine. Caffeine may trigger headaches in some people.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink.
• Try to get at least 7 to 9 hours of sleep each night.

If you find that you are taking medicine for headaches often, it is important that you talk to your healthcare provider. There are many ways to help manage pain. Medicine is one way, but other methods can be used instead of or with medicine.

You can get more information from:

• American Council for Headache Education (ACHE)
  800-255- 2243
  http://www.achenet.org
• National Headache Foundation
  800-843-2256
  http://www.headaches.org