3/27/07 Podcast: Rebound - When Our Medications Cause Headaches

The transcript of this podcast is below. Ifyou prefer to listen to it, you can do so easily from the MigraineCast Web site.



Welcome to MigraineCast, the weekly podcast brought to you by MyMigraineConnection.com and the HealthCentral Network. They're a conundrum, a vicious cycle, a Catch-22. I'm talking about medication overuse headaches, also known as rebound.

In a recent poll on MyMigraineConnection.com, only 3% of respondents said that they're doctors told them about rebound before they experienced it. 26% said their doctors explained it after they experienced it. The remainder? Their doctors never explained it at all. Sad statistics.

So, what is medication overuse headache or rebound? Notice that I said overuse, not misuse or abuse. In a nutshell, medication overuse headaches are headaches caused by taking pain medications or Migraine abortive medications too often, which is more than two or three days a week. Medication overuse headaches make things even more complicated for chronic headache and Migraine sufferers. It's like the old phrase, "adding insult to injury." The very medications we take for relief come back and bite us in the behind. A simple way to describe it is that it's as if, after a few days of taking a medication, our bodies begin to like it. Then, when we don't take the medication, the body asks itself what it did to get the medication before. It had a headache? OK, it will just produce another headache to get us to give it the medication again.

Unfortunately, most of the medications we take to relieve a Migraine attack or headache, both over-the-counter and prescription medications, have been found to cause medication overuse headache. Acetaminophen, ibuprofen, aspirin, combination products such as Excedrin. We tend to think anything over-the-counter is safe, but when you're prone to headaches and Migraines, these products can be major culprits in actually making things worse if taken too frequently. Vicodin, Percocet, Fioricet. These compound prescription analgesics contain multiple ingredients that can cause rebound. The triptan medications such as Imitrex have also been know to cause medication overuse headache. The exception may be the longer half-life triptans, Amerge and Frova, which have been studied, taken daily for a week around the menstrual cycle, to prevent menstrually associated Migraines.

The logical question is, "What do we do when we have headaches or Migraines more than two or three days a week?" This is when we must work with our doctors to find an effective preventive regimen. Finding that effective regimen, however, isn't always a quick process. It can involve trial and error, leaving us with frequent headaches and Migraine attacks during the process. A method many Migraine and headache specialists employ for Migraineurs is to prescribe a triptan that can be taken two or three days a week and a pain medication that can be taken two or three other days a week. That give us four to six days a week that we can treat Migraines. It's more difficult with chronic headache for which triptans don't work because that reduces treatable days to just two or three a week.