Rebound headache

Rebound headache, also known as medication overuse headache (MOH), is a condition where frequent use of pain relief medications leads to persistent head pain. The headache persists despite or because of continuous use of medication intended to treat headaches. This condition is a common complication of headaches, particularly migraines and tension headaches.

Causes

Rebound headaches are caused by regular, long-term use of medication to treat headaches. Medications most commonly associated with this condition include paracetamol (acetaminophen), aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs), and caffeine. Prescription medications, such as triptans, ergotamines, and opioids, can also lead to rebound headaches when used frequently.

Symptoms

The primary symptom of a rebound headache is a persistent headache that occurs daily or almost daily, often waking the sufferer in the early morning. The headache may vary in intensity but typically has a dull, pressing quality. Other symptoms may include:

• Nausea
• Restlessness
• Difficulty concentrating
• Memory problems
• Irritability

Diagnosis

Diagnosis of rebound headache is based on the patient's history of headache and medication use. Criteria include headaches occurring on 15 or more days per month in a patient with a pre-existing headache disorder who regularly overuses headache medication. Withdrawal of the medication often leads to improvement of the headache.

Treatment

The primary treatment for rebound headache is the discontinuation of the medication causing the condition. This process can be challenging and may lead to withdrawal symptoms, including increased headache, nausea, vomiting, and sleep disturbances. Gradual withdrawal is often recommended to minimize withdrawal symptoms. Additional treatments may include the use of preventive headache medications and behavioral therapies, such as cognitive-behavioral therapy (CBT).

Prevention

Prevention of rebound headaches involves the judicious use of headache medications. It is generally recommended to limit the use of any headache medication to no more than two days per week. Patients with frequent headaches should be evaluated for preventive headache treatments.

See Also

• Migraine
• Tension headache
• Chronic daily headache
• Drug withdrawal