Ultram is rather paradoxical. For some people, taking it more than two or three days a week for Migraine or headache does cause MOH. On the other hand, if you need pain relief for something other than headache or Migraine, it seems to be less likely to cause MOH than many other pain relievers.   The general rule of thumb is that if you're having more than three Migraines or debilitating headaches a month, it's healthier to use preventives to reduce the number of headaches or Migraines we have.   Sorry not to be able to give you a more definite answer, but there just isn't one in this case.   Teri