A medication overuse headache, or rebound headache, occurs when you treat headaches with medication too often, leading to even more headaches.

Medical professionals classify headaches into two categories:

Primary headaches

These types of headaches include tension headaches, migraines, or cluster headaches. Primary headaches are more common and represent more than 95 per cent of all reported headaches.

Secondary headaches

This is where the headache is a symptom of some other underlying health condition, such as high blood pressure or a sinus cold. Medication overuse headaches are characterized as a secondary headache.

What is a medication overuse headache?

Medication overuse headache is often the result of a continuous cycle of headache pain/relief from the long-term use of medication. These drugs can include prescription medications (e.g., triptans, ergotamines, opioids, combination analgesics) used to treat migraine and tension headaches, but can also result from overusing over-the-counter painkillers such as acetaminophen and ibuprofen.

Certain prescription medications, and especially those that contain controlled medications like opioids and barbiturates, are most likely to cause rebound headaches.

How is a medication overuse headache diagnosed?

Your physician or nurse practitioner may diagnose a medication overuse headache if:

• You have headaches for 15 or more days per month AND a pre-existing headache disorder;
• Use over-the-counter headache medication such as acetaminophen (Tylenol®), acetylsalicylic acid (aspirin), and non-steroidal anti-inflammatory drugs (NSAIDs, like Naproxen or Advil®) approximately 10-15 days per month;
• Regularly take prescription headache medication for 10 or more days each month; or
• If there is no better explanation by another diagnosis.

What are the symptoms of medication overuse headache?

The symptoms of medical overuse headache involve many of the features that you are trying to treat, including pain, nausea, fatigue, restlessness, trouble concentrating, memory problems, or irritability.

Often, these symptoms occur daily or every other day. The severity of your symptoms will vary depending on the medications used or for the underlying medical reasons for treating headaches. The symptoms that you are trying to treat quickly rebound or worsen once medications wear off.

How is a medication overuse headache treated, and what can I do to prevent it?

If you think you may have medication overuse headaches, there is a path forward. Treatment often involves:

• Stopping or reducing the frequency of the medication you are overusing to treat your symptoms. Your health care provider can advise on how to do so, safely and effectively.
• Switching medication with an alternate drug to treat your headache symptoms.
• Trying non-medicinal treatments such as biofeedback, relaxation training, or working with a registered psychologist to help you adjust your mind and body to changes in your treatment.
• Talking to your regular health care provider and community pharmacist if your headaches persist or worsen.

You should always follow your healthcare provider’s guidance on medication dosage and how often to take them. This is an essential part of helping you avoid rebound headaches.

Don’t take medications—even over-the-counter ones—more frequently than is recommended. Your pharmacist is a good source of information, if you are unsure of how often is too often to take pain medications.

Does caffeine make rebound headaches worse?

Yes, especially if you consume more than 400 milligrams of caffeine a day. That’s roughly four cups of brewed coffee or two energy drinks. While colas usually don’t contain as much caffeine, the added sugar can contribute to headache symptoms as well.

The information provided in this article is for personal use, reference, and education only. ASEBP does not provide medical advice. Before starting any medication or product, you should always consult with your pharmacist, health care provider, or call Alberta Health Link at 811.