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Rebound Headaches Not a Disease

By on November 1, 2017
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MOST OFTEN SELF-INFLICTED… SOMETIMES WITH THE HELP OF DOCTORS 

BY: DR. JOHN McELLIGOTT, DR. JOHN’S MEDICAL SOLUTIONS

Rebound headaches are very common in truckers who self-medicate a headache or other pain conditions.

Sometimes prescribed by a healthcare provider, but more often obtained over the counter (OTC) at local drug stores, big box retailers and truckstops, these medications include BC powder, aspirin, acetaminophen (Tylenol), ibuprofen (Advil), or any combination of pain relievers designated for simple pain relief. Some containing stimulants like caffeine are often the start of recurrent headaches known as rebound or overuse headaches.

Medication Overuse (MOU) syndrome is more descriptive than rebound, since repetitive use of an OTC remedy for headaches or other aches and pains is the beginning of what can lead to a symptom complex that results in repetitive headaches. They usually occur every day or nearly every day, often waking you in the early morning. Pain relief medication generally works temporarily, but pain then returns as your medication wears off. This is when rebound headaches are likely to occur. Underlying the cycle of pain relief and return are other MOU symptoms as discussed in an excellent Mayo Clinic article:

  • Nausea
  • Listlessness
  • Restlessness and difficulty concentrating
  • Memory problems
  • Irritability

Other Causes
Keep in mind that OTC medications are not the only cause of Overuse Headaches. Several classes of prescription (Rx) medications and daily drinks can produce the same symptom complex. This is another brief list provided by the Mayo folks:

Migraine Medications. Various migraine medications have been linked with rebound headaches, including triptans (Imitrex, Zomig, others) and certain ergots, such as ergotamine (Ergomar, others). These medications have a moderate risk of causing medication-overuse headaches. The ergot dihydroergotamine (D.H.E. 45) appears to have a lower potential for causing this problem.

Opiates. Painkillers derived from opium or from synthetic opium compounds include combinations of codeine and acetaminophen (Tylenol with Codeine No. 3 and No. 4, and others). These medications have a high risk of causing rebound headaches. Daily doses of caffeine—from your morning coffee, your afternoon soda, and pain relievers and other products containing this mild stimulant—may fuel rebound headaches, as well. Read product labels to make sure you’re not affecting your system with more caffeine than you realize.

Diagnosing Rebound Headaches

Here is the hard part: diagnosing rebound/medication overuse headaches!

Recently, I reviewed a case of a driver who had recurring headaches 3-4 times each week for seven years. His family doctor tried all the usual migraine meds with only brief relief to start, and then no relief. Neurological evaluations and treatments were initiated with no results (brain scans were negative). Eventually, it was revealed the driver was addicted to OTC meds, opiates, and energy drinks. In addition, he began smoking and dipping since the nicotine seemed to help speed up the effect of the pain pills.

After reviewing the facts, I determined this was a severe case of MOU, made worse by the consumption of tobacco and nicotine. With this driver, simply “Breaking the Cycle” would most likely not work, so I recommended hospitalization. This is a recommendation made by medical experts when these factors are in play:

  • Unable to stop using pain medication on his/her own
  • Have other conditions, such as depression or anxiety
  • Are taking high doses of drugs that contain opiates or the sedative butalbital
  • Are abusing substances such as tranquilizers, opioids or barbiturates
  • Have limited or no family support

This treatment is for a short period, usually two to three days. Close follow-up is needed just in case preventive medications are required. For less severe cases, I typically prescribe what is called a beta blocker. Most often it’s propranolol. This medication addresses the anxiety related to folks with MOU. In addition, propranolol blocks the fight or flight reaction found in many truckers after a battle with 4-wheelers all day long, causing the headaches that started this whole symptom complex.

To help prevent rebound headaches:

  • Take your headache medication as prescribed.
  • If you need headache medication more than twice a week, contact your doctor.
  • Avoid medications that contain butalbital or opioids.
  • Use OTC painkillers less than 15 days a month.
  • Limit use of triptans or combination analgesics to no more than nine days a month.
  • Taking care of yourself can help prevent most headaches.

Avoid headache triggers. If you’re not sure what triggers your headaches, keep a headache diary with details about every headache. Eventually, you may see a pattern.

Get enough sleep. Go to bed and wake up at the same time every day—even on weekends.

Don’t skip meals. Start your day with a healthy breakfast. Eat lunch and dinner at about the same time every day. Drink enough water.

Exercise regularly. Physical activity causes your body to release chemicals that block pain signals to your brain. With your doctor’s OK, choose activities you enjoy—such as walking, swimming or cycling. To avoid injury, start slowly.

Reduce stress. Get organized. Simplify your schedule. Plan ahead. Try to stay positive.

Relax. Try yoga, meditation or relaxation exercises. Listen to music, read a book or take a hot bath.

Lose weight. Obesity can contribute to headache development; so if you try to lose weight, find a program that works for you.

Quit smoking. If you smoke, talk to your doctor about quitting. Smoking can trigger headaches or make them worse.

Remember you must always talk to your personal doctor. Do not just read and self-treat.

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