Full Question:

Hi, I would like a little more info on how to identify rebound headaches. Are they quantity or drug days related. I ask because I can take 1/4 to 1/2 a tab of Ercaf along with Tylenol 3 and caffeine to abort a headache, but I'll often get another within 2 days, and then not get another for 5 to 7 days.

What I really want to know, is it better to take larger quantities less days per month or small quantities but possibly more days per month, or does it matter? Also, how do I identify a rebound headache. I think I've been able to stay away from them so far but....

I've had migraines since I was little, 55 years ago. Before ergot they were debilitating to put it mildly. They were so painful (full body and mind awful) I think I'd be dead by now either by headache or own hand if not for ergot. Now at least I can cope. Thanks, Chris.

Full Answer:

Dear Chris;

Truthfully, it's always best to manage with as little acute medication (medication taken to treat a Migraine attack when it occurs) as possible. That's not to say that Migraines shouldn't be treated, but they should be treated with the least amount of medication possible to be effective. With the Ercaf / Tylenol 3 / caffeine regimen you describe, keep in mind that Ercaf contains caffeine, so you're doubling up on it. Also, the codeine in the Tylenol 3 is a potential problem because research is showing that any use of opioids can increase the risk of developing transformed Migraine. (see Transformed Migraine - Risk Increased by Some Medications.)

When it comes to avoiding medication overuse headache (MOH), aka rebound, it's the number of days per month that needs to be limited. Of course, you should not take more than the recommended amounts of medications at any time, but that's another issue.

Have you tried other Migraine abortive medications? When possible, it's best to use a Migraine abortive when a Migraine strikes and reserve medications such as Tylenol 3 for rescue medications to be used if your abortive fails. Migraine abortive medications include:

• The triptans: There are seven medications in the triptan family-- Imitrex, Maxalt, Zomig, Amerge, Relpax, Axert, and Frova -- as well as Treximet, which is a combination of Imitrex and Naproxen Sodium. Each of the triptans binds to different combinations of serotonin receptors, which is why our bodies may respond differently to each of them. It's well worth discussing the ones you haven't tried with your doctor.
• The ergotamines: In addition to Ercaf, there's D.H.E. 45 for subcutaneous injection and Migranal Nasal Spray.

If you're experiencing three or more Migraines a month, it would be advisable to talk with your doctor about preventive therapies.

For more information about medication overuse headache, see Medication Overuse Headache: When the Remedy Backfires.

Good luck,
John Claude Krusz and Teri Robert

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