Medication Overuse Headache: How Simple Analgesics can Worsen Headache Symptoms

Most individuals aren’t terribly bothered by headaches, thanks to effective over-the-counter analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. However, individuals with episodic and chronic headache, particularly migraine, can be greatly affected, with headaches lasting multiple hours or even days, and resulting in significant disability. While medications such as triptans can effectively treat acute migraine symptoms, patients need to be aware that overusing these drugs can actually make the headaches worse: a condition known as medication overuse headache (MOH).

Patients taking triptans or NSAIDs 15 days or more per month (Katsarava & Obermann, 2013), or who take opiates 8 or more days per month (Tepper & Tepper, 2014) are at risk for developing MOH. Individuals who develop MOH, also described as “rebound headaches,” may experience chronic daily headaches. The natural reaction to this is to take more analgesics, which only perpetuates this vicious circle. Effective treatment involves weaning the patient completely off of the overused medication using a bridge therapy, followed by a plan for long-term preventative treatment using safer levels of medication. Since the bridge therapy may involve infusions, it is often offered within a day-hospital outpatient setting (Tepper & Tepper, 2014).

One of the keys to effective long-term treatment is to manage expectations about what headache therapy can accomplish. For those who suffer from migraines, it may be unrealistic to expect a complete cure. Rather the goal should be functional: to return to the activities that are important for living a fulfilling life. For most people this would include school and/or career, family and social interactions.

Cognitive behavioral therapy can be an important piece of the puzzle since maladaptive thought patterns such as catastrophizing can certainly intensify one’s perception of pain. Lifestyle changes such as avoiding food triggers and getting more exercise are non-pharmacological methods of reducing headache intensity. A supportive circle of family members and friends makes a huge difference as well, since remission from rebound takes time.

There is a silver lining for migraine sufferers. Migraine peaks relatively early in life. Highest prevalence is between ages 20 and 45 (Mitsikostas & Paemeleire, 2015). After that, the frequency and intensity of headaches tends to wane. Women, who as adults tend to experience more migraines than men, may experience a significant reduction of symptoms following menopause.

Other non-pharmacologic therapies for the treatment of chronic headache include transcutaneous electric nerve stimulation (TENS), acupuncture and biofeedback. Keeping a headache diary can help to identify times of day when headaches most often occur and headache triggers. For those who are experiencing an uptick in headache symptoms, it may be time to contact a physician specializing in headache medicine. To locate a provider, visit the National Headache Foundation website.

Leave a Reply

Your email address will not be published.