medication overuse headaches
Living With Chronic Pain

Over-the-Counter Medicines May Cause Headaches

We’ve all been there. A headache that feels like a drum set is playing incessantly. That’s when we reach for a quick fix. But sometimes the fix can be worse than the pain. If taken regularly, those very medicines may be causing the pain, not relieving it.

Medication overuse headaches (MOH) or rebound headaches are caused by regular, long-term use of medications commonly used to treat them. Pain relievers may offer relief in the beginning, but some, when taken for more than a couple of days a week, may actually trigger those headaches. If you have chronic headaches, any medication you take for relief can become the enemy. 

Some 60 million people around the world suffer from headaches brought on by the overuse of medicines. When the pain doesn’t ease the reflex is to take another pill. When that doesn’t help, try another one, setting the scene for a viscous cycle of “rebound” headaches.

How much is too much?

Instead of a headache that might call for pain medications two or three times a week, people with MOH may now have headaches daily, typically upon awakening. For many, this is a new level of chronic pain – and there’s no miracle pill to fix it. Unfortunately medication overuse headaches can also cause memory issues, difficulty concentrating, depression, anxiety, irritability, restlessness and nausea.

Just how much pain medication will cause a rebound headache depends on the medicine. Over-the-counter pain relievers, such as aspirin, acetaminophen, ibuprofen, naproxen and indomethacin, can cause MOH when used 15 or more days per month. 10 days for those that contain a combination of caffeine, aspirin and acetaminophen as well as tryptamine- and ergotamine-based drugs often prescribed for migraines, and any of the opiates: oxycodone, tramadol, butorphanol, morphine, codeine or hydrocodone.

Just 200 milligrams of coffee will also trigger a medication overdose headache. That’s just one cup of coffee combined with a coke and a plain chocolate bar. 

How can they be prevented?

Medication use:

  • Take medications only as prescribed.
  • If needed more than twice a week, contact your provider.
  • Avoid medications that contain butalbital or opioids.
  • Use-over-the counter painkillers less than 15 days a month.
  • Limit use of triptans or combination analgesics to no more than nine days a month.

Self help:

  • Avoid headache triggers. If unsure what triggers your headaches, keep a diary-eventually a pattern may emerge. Check back for more on triggers next week.
  • 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.
  • Stay hydrated. Be sure to drink plenty of water or other uncaffeinated fluids.
  • Exercise regularly. Physical activity causes your body to release chemicals that block pain signals to your brain. With your providers OK, choose activities you enjoy -such as walking, swimming or cycling.
  • Reduce stress. Get organized. Simplify your schedule, and plan ahead. Try to stay positive.
  • Lose weight. Obesity can contribute to headache development, so if you need to lose weight, find a program that works for you.
  • Quit smoking. If you smoke, talk to your provider about quitting. Smoking is linked to a higher risk of medication overuse headaches.

What treatments work?

It has long been debated whether any preventative treatments were necessary to help patients wean off medications – believing the vast majority of patients did just as well with a cold-turkey approach. Especially when most withdrawal headaches improved in less than a week. Possible exceptions included those who take large doses of sedative hypnotics, sedative-containing combination headache pills, or narcotics such as codeine or oxycodone. Hospitalization may be required to wean them off their medications. 

But a study in the JAMA Neurology, showed the largest reductions in headache and migraine days were seen when preventative medicine treatments such as anticonvulsants, antidepressants, beta blockers, calcium channel blockers and Botox injections were added. In addition, people who withdrew from meds with the help of preventatives had a significantly higher chance of being cured of their medication overuse headaches than patients who used preventatives or withdrawal alone. 

When should I see my provider?

Occasional headaches are common. But it’s important to take your headaches seriously. Some types can be life-threatening.

Seek immediate medical care if your headache:

  • Is sudden and severe
  • Accompanies a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
  • Follows a head injury
  • Gets worse despite rest and pain medication
  • Is a new type that’s persistent, especially in someone older than 50
  • Occurs with shortness of breath
  • Happens when you’re upright but goes away if you’re lying flat

Consult your provider if:

  • You usually have two or more headaches a week 
  • You take a pain reliever for your headaches more than twice a week 
  • You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches 
  • Your headache pattern changes

Whatever the cause, when headaches persist find out which plan of action will work best for you.

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