Most people with chronic daily headache are experiencing rebound headaches.  The medication which is being used for today's pain “rebound” and cause tomorrow's headache.

Typically rebound headaches are described as daily or almost daily, bilateral, continuous or almost constant, dull tension type headache.  People usually are using daily or almost daily pain medications for its treatment.  In addition almost all of these people have superimposed migraine attacks, which are more frequent, more intense and more prolonged than any episodic migraine they might have experienced in earlier years.  After developing the daily headaches many people start noticing symptoms of depression including fatigue, weakness, difficulty sleeping, and trouble thinking clearly.  Some people note mild elevations of blood pressure and/or symptoms of fibromyalgia.

The unusual presentations of rebound headache and include:

• Only unilateral headache or even localized pain.
• Very frequent migraine attacks without a tension type headache component.
• Young children with chronic daily headaches.
• Chronic daily headache despite only using one or two analgesic tablets each day.
• Development of daily headaches by using daily medications for pain for short periods of time but then development of daily headaches after reducing the medications to only one or two days per week.
• People whose headaches began following head injury which are commonly misdiagnosed as chronic post traumatic headache.

Medications which might cause this phenomenon include aspirin, acetaminophen (Tylenol), any non-steroidal anti-inflammatory drug (including Aleve, BC powders, Bufferin, Excedrin, Excedrin migraine, Fioricet, Motrin, naproxen), any opiate (codeine, Demerol, Fentanyl, morphine, OxyContin, Stadol, Ultram), ergotamine (Cafergot, Methysergide, with the exception of DHE 45), any tryptan (Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, and Zomig; see our section on acute migraine treatment) or any combination of the above.  The exact role that caffeine plays in causing rebound headaches is unknown.

It is very important to know that medications to prevent headache and antidepressants are ineffective in treating this type of headache as long as the offending agent(s) are still used.

The chemical basis for rebound headache is possibly a change in serotonin receptors.  There is no laboratory test for this condition.  The diagnosis can only be confirmed by observing the gradual reduction and finally the termination of the previous daily headache after the offending pain relief medications have been completely withdrawn.

Upon withdrawal of the offending agents they headache might intensify for the first week.  Your doctor may consider adding preventative medication for headaches as noted in our section for acute migraine treatment in an attempt to make this period more tolerable for you.

The endpoint of treatment should be six consecutive pain-free days.  In the meantime to reach this goal is three months and some people may need six to 10 months to get there.

Once you have reached the treatment goal here are the important points to consider in preventing this headache from reoccurring:

• Limit the previously forbidden pain medications to 2 days per week.  If this limit is exceeded, there is a risk of return of the daily headaches.
• Caffeinated beverages can be resumed.  There's a very slight risk of return of the daily prolonged headache.  If this type of headache returns stop the caffeine.
• Triptans can be used at the onset of migraine but should not be taken more often than twice a week.

If you have questions or comments regarding this topic that you would like for us to address here in the future please don’t hesitate to email us at Headache@Wisedoctors.com.