Headache is a common problem. Nearly every person will experience at least one headache in their lifetime. Most are successfully treated with some kind of analgesic medication, ranging from over-the-counter (OTC) pain relievers to prescription medications. Imagine, however, the headache returns and requires additional medication and the cycle continues on a daily or near-daily basis. The problem? Analgesic rebound headache.
Definition/Incidence
Analgesic rebound headache, or medication overuse headache (MOH), is defined by the International Headache Society as headache that occurs on 15 or more days per month and resolves or returns to its previous pattern within two months of discontinuation of the offending drug. As a result, MOH can only be conclusively diagnosed by a trained clinician in retrospect. Approximately 1 to 2 percent of the population suffer from MOH, which often begins as a mild to moderate tension-type headache. Patients typically experience a predictable onset of headache corresponding to the time when the analgesic effect of their medication is declining.
Causes
MOH may be caused by any analgesic medication, including OTC analgesics (acetaminophen, ibuprofen or aspirin), prescription "triptans" (sumatriptan or Imitrex), narcotics (oxycodone or acetaminophen with codeine), ergotamine drugs or other combination products. Medications containing caffeine are more likely to produce rebound headache; people who ingest caffeine are also at higher risk for developing MOH.
Significance
Overuse of headache medications may have adverse outcomes in addition to MOH. Liver and kidney damage, in addition to gastritis associated with some anti-inflammatory agents, can result from overuse.
Treatment
According to the International Headache Society, the cornerstone of MOH treatment is removal of the causative medication. Abrupt discontinuation may be difficult and result in severe headache, as well as gastrointestinal and emotional distress, which may persist for up to three weeks. Discontinuation is best conducted as a joint effort between patient and prescriber. A thorough examination of root causes of the headache can be explored, in addition to possible preventative medications or treatments.
Summary
Although analgesic rebound headache or MOH is a significant problem, it is one with a known cause and a clear treatment. Discontinuation of the offending drug is likely to decrease headache frequency.
References
- "Practical management of medication overuse headache"; Acta Neurologica Belgium; Koen Paemeleire, Luc Crevits, Peter J. Goadsby and Holger Kaube; June 2006
- International Headache Society: International Classification of Headache Disorders
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