Medication overuse headaches

It is not clear what causes these types of headaches. One possibility is that the nervous system gets used to the medications and then reacts even more sensitively to pain stimuli and triggers. In other words, a stimulus that the brain doesn’t normally register as pain is then perceived as being painful. But there are lots of unanswered questions, such as why people who often take painkillers for other illnesses like chronic joint pain don’t get these kinds of headaches.

Medication overuse headaches cause a dull pain that affects the entire head. There are usually no other symptoms. But sometimes people experience an attack of an existing primary headache conditions along with the permanent headache: The pain then caused by migraine, for example, is more of a throbbing pain and other migraine symptoms develop as well. Medication overuse headaches are chronic, meaning that they occur on more than 15 days per month over a period of three months.

At first, people with medication overuse headaches often think that their migraine or tension headaches have simply gotten worse. Many of them then start taking more painkillers or migraine medication.

That is why finding out how often you are actually supposed to take the medication is the first step to getting out of this vicious circle. A headache diary and/or medication diary can help with that. You can use it to record when you have had headaches or have taken painkillers. It is then possible to tell if medication overuse might be the reason your “usual” headaches have changed.

People who notice that they regularly take painkillers or migraine medication on more than ten days per month should speak to their doctor. It is possible that you might have developed medication overuse headaches in addition to your primary headaches.

You will then have to stop taking the medication for about 7 to 14 days to diagnose the medication overuse headaches and treat them. If the headaches are caused by medication overuse, the pain gets better and less frequent after a few days. But it can get worse at the beginning of the break before it gets better. Nausea, restlessness, and insomnia are also possible. That's why it's best to plan the break for a time when you are less busy and can talk to your doctor at short notice if needs be. They can then prescribe you with antiemetics against the nausea. Some people also find it helps to dab a little peppermint oil on their forehead or temples. Medications containing cortisone are sometimes used, too. But it would seem that they are no more effective than a placebo at relieving the pain shortly after stopping taking the medication.

A medication break can be done as an outpatient procedure. But it might sometimes be a good idea to stay in hospital, for example if you have already unsuccessfully tried a few times to reduce the amount of painkillers you take. Techniques like cognitive behavioral therapy might be offered in hospital to help with reducing medication.

You can take painkillers or migraine medication again for acute headaches after the medication break. But the rule is always that you shouldn’t take them more than ten days per month and only for three day in a row at most. Lots of people relapse within the first year after stopping the medication and then start taking them more regularly again. That is why it is important to stay in contact with your doctor after successfully stopping.

Preventive treatment (prophylactic therapy) is another option if you don't want to stop taking medication. Products such as topiramate or botulinum toxin type A are then taken as a preventive measure for migraine, or amitriptyline for tension headaches. The aim of preventive treatment is to prevent the pain attacks and make sure that painkillers or migraine medication are not needed on more than ten days per month.