As if there were not enough headaches described by human beings, one more has been added to the list. Worse than that, though, is that the cause of this headache is known. The culprit is the very medication that you take to get rid of headaches. Let's say that you have a headache 2 to 3 times per week. Through trial and error you find that a certain medicine, say Excedrin, works very well. Over time you notice that you are having more frequent headaches, but that the Excedrin is still doing the job. Then you notice that you need to take more Excedrin for each episode to do the trick, and the frequency is increasing until you are suffering from daily headaches. You are now in the midst of rebound headache phenomenon.

A rebound headache is defined as perpetuation of head pain in chronic headache sufferers secondary to frequent and excessive use of symptomatic medication. Over the counter analgesics (pain relievers) of any kind are the most common culprit, but overused prescription medications used to abort a migraine or cluster headache, like those from the triptan class, may be responsible as well. How does this happen? Pain relievers turn off pain receptors in the brain. Experts think that rebound begins when a chronic headache sufferer takes pain relievers more than 2 to 3 times per week. For some reason, they believe, the pain receptors become unusually sensitive. As soon as the medicine wears off, these extra sensitive receptors turn on and produce a new headache. Then the headache sufferer takes more medicine, which leads to more headaches. Before long, most rebound patients are taking headache medicine every single day. Stopping the cycle requires stopping the medication. The withdrawal is difficult, with the ensuing headaches likely to be the worst of your life. For this reason, many physicians will suggest doing this as an inpatient at a headache center or hospital for at least the first few days.

How do you know if your headaches are just your migraines or a consequence of rebound? There are some clinical features that are known to be present in rebound situations: First, the headache occurs daily or near daily and occurs in a patient with a primary headache disorder who uses immediate relief medications very frequently, often in excessive quantities. The headache varies in intensity, type, severity, and location from time to time and only minor physical or mental efforts are required to bring on headaches. The threshold for pain is low and the headache is accompanied by weakness, nausea and other GI symptoms, restlessness, anxiety, irritability, memory problems, difficulty concentrating, or depression. There is drug-dependent rhythm to the headaches and evidence of pain medication tolerance over a period of time. Withdrawal symptoms occur when medications are stopped abruptly, then the headaches spontaneously improve after a few days. Finally, preventive medications do not work well while the sufferer is consuming excessive amounts of pain relievers.

Many primary headaches occur frequently, even daily, to as few as one severe headache per year. Rebound transforms episodic migraines into chronic ones. Rebound also transforms episodic tension type headaches into chronic daily headaches. If you are having more than 2 per week, you should see your doctor and ask about headache prevention. For some, prevention does not work, but if you haven't tried, you don't know. To take pain relieving medicine, whether over the counter or prescription, that frequently means that your headaches are not managed or controlled. Daily headaches absolutely mean that some sort of intervention is required. Stopping the rebound effect will reduce the frequency of your headaches; it will not cure the underlying primary headache disorder. You will still need to investigate alternate methods of managing your headaches, lest you get caught in the cycle again.