When the occasional headache strikes, most of us head for the medicine cabinet or local pharmacy and take an over-the-counter
analgesic, such as acetaminophen, ibuprofen, aspirin or pain-relieving medications containing caffeine.
While over-the-counter analgesics are helpful in improving headache pain, they must be taken with caution because they could
actually make your headaches worse if they aren’t taken correctly. The overuse or misuse of analgesic medications — exceeding
labeling instructions (such as taking the medications three or more days per week) or not following your physician's advice —
can cause you to "rebound" into another headache. When the pain medication wears off, you may experience a withdrawal reaction,
prompting you to take more medication, which only leads to another headache and the desire to take more medication. And so the
cycle continues until you start to suffer from chronic daily headaches with more severe headache pain and more frequent headaches.
Analgesic-overuse appears to interfere with the brain centers that regulate the flow of pain messages to the nervous system,
worsening headache pain.
This rebound syndrome is especially dangerous if your medication contains caffeine, which is often included in many medications
to speed up the reaction of the other ingredients. While it can be beneficial, caffeine in medications, combined with consuming
caffeine (coffee, tea, soft drinks or chocolate) from other sources, makes you more vulnerable to a rebound headache.
In addition to the rebound headache, over-use of analgesics can lead to
addiction, more intense pain when the medication wears off, and possible serious
side-effects.
Who is affected by analgesic-induced chronic daily headaches?
Any patient with a history of tension-type headaches, migraines or transformed migraines can be affected by rebound headaches if
he or she overuses certain medications. Some patients -- although they are few in number -- can quickly develop rebound headaches
by overusing analgesics, even without having knowingly been a headache sufferer.
What analgesics are responsible for causing rebound headaches?
Many commonly used immediate relief medications, when taken in large enough amounts, have been found responsible for inducing
rebound headaches.
Studies are being done indicating that medications once thought of as "safe" are the likeliest culprits. Among these medications
are aspirin, sinus relief medications, acetaminophen, non-steroidal anti-inflammatory medications (NSAIDs), sedatives for sleep,
codeine and prescription narcotics, and over-the-counter combination headache remedies containing caffeine (such as Anacin,
Excedrin, Bayer Select and others). Other medications commonly associated with rebound headaches are ergotamine preparations
(Cafergot, Migergot, Ergomar, Bellergal-S, Bel-Phen-Ergot S, Phenerbel-S, Ercaf, Wigraine and Cafatine PB), butalbital combination
analgesics (Goody’s Headache Powder, Supac, Excedrin) and opiates (codeine). The triptans, which are migraine specific medications
and include Imitrex, Zomig, Maxalt, Relpax, Axert, Frova and Amerge taken more than 2 times per week can also cause rebound.