Analgesic rebound headache

Other Names: Rebound Headache, Analgesic Overuse Headache

What is Analgesic Rebound Headache?

Analgesic rebound headache is a common type of headache that occurs on a daily or near daily basis.

Why does Analgesic Rebound Headache occur?

Many experts believe that these headaches occur when short acting pain medications wear off. This triggers the next headache, which in turn leads to more medication being taken. A vicious cycle of medication use and headache develops.

What causes Analgesic Rebound Headache?

Analgesic rebound headaches are caused by the daily or near daily use of medications used for the immediate relief of headache pain. These headaches often develop if the analgesics are used more than 2-3 days per week on a regular basis.

What medications can lead to Analgesic Rebound Headache?

Any immediate relief medication used to treat acute headache pain can cause this type of headache. Examples include:

  • Acetaminophen
  • Aspirin (including aspirin/caffeine containing compounds)
  • Excedrin/Excedrin Migraine (or their generic equivalents)
  • Fiorinal/Fioricet (or their generic equivalents)
  • Codeine, Propoxyphene, Hydrocodone, Oxycodone, Meperidine
  • Ibuprofen, Naproxen, Ketoprofen
  • Stadol nasal spray

Learn more about the brand name version of any of the above medications.

In general, all migraine pain relievers may have the potential for causing rebound headaches. Even the triptan medications can cause this type of headache if overused.

What are the common characteristics of Analgesic Rebound Headache?

  • Daily or near daily headache
  • Headaches can vary in severity and location
  • Even the slightest physical or mental effort can trigger the headaches (threshold for pain is lowered)
  • Nausea, restlessness, anxiety, irritability, insomnia, depression, difficulty concentrating
  • Predictable early morning headaches noted
  • Tolerance to pain relievers develop; Patient needs more medication to get the same level of pain relief.
  • preventive medications usually become much less effective when analgesics are used frequently

What is the prognosis for patients with Analgesic Rebound Headache?

Headaches may get worse for the 4-7 days following withdrawal of the immediate relief medications. The good news once the cycle is broken and the immediate relief medications are not taken regularly, the headache pattern usually improves greatly. Often the patient reverts back to having intermittent, much easier to treat, headaches. Your doctor will suggest a variety of options, both drug and non-drug, to treat the pain during this withdrawal period.

Is hospitalization ever needed?

Most cases of analgesic rebound headache can be successfully treated as an outpatient. Rarely, a 2-3 day inpatient stay may be needed to break the cycle, especially if the overused medications were narcotic pain relievers or medication used in very excessive amounts.

Where can I learn more about Analgesic Rebound Headache?

The American Council for Headache Education (ACHE) Web site offers additional resources.