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Migraine Triggers : Medication Overuse Headache

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Q: Can my medication give me a headache?
A: Yes, there are medications that, taken on a routine basis, can cause a headache known as medication overuse headache (previously called rebound headache). Some medications are known to induce headaches, while the effects of others remain controversial. It is important that you do not use any migraine-relief medication for more than 2 days a week. Therefore, an aggressive preventive treatment program is essential.
Q: Why do I need to be concerned about medication overuse headache?
A: In headache clinics in the US, nearly 80 percent of patients with chronic daily headache (more than 15 headache days per month) have medication overuse headache. If you are among the millions whose headaches have become chronic, you probably have medication overuse headache in addition to your main headache disorder.
Q: What are the symptoms of medication overuse headache?
A: The daily headaches may vary depending upon the type of medication that is being overused. Those caused by the excessive use of analgesics resemble tension headaches, whereas triptan  overuse headaches are more like migraine headaches. The headaches caused by medication become more frequent over time, causing the user to become dependent upon the medication. This is not an addiction, but it is a dependency because if you do not take the pill, you get a severe headache. The more you take the pills, the more headaches you have, and the more pills you need to take.
Q: How do I avoid medication overuse headache?
A: Taking a medication for a headache for more than 3 days a week can cause medication overuse headache. A treatment program that includes effective therapy to stop migraine attacks without the overuse of medications is essential for the control of migraine. If migraine attacks are occurring more than 3–4 times a month, then preventive medication may be needed. Daily medications do not have to be taken forever. Once you reduce the frequency of migraine to less than 2 attacks a month, you can slowly reduce the preventive medication.
Q: Could a certain medication that I am taking for another problem cause medication overuse headache?
A: Yes, frequent use of analgesics for any type of pain can cause medication overuse headaches in individuals with migraine. Many people with medication overuse headache think their headaches have a different cause. For example, they may believe that their headache is due to a sinus problem or an allergy because many of the medications used to treat sinus congestion and allergic symptoms can cause medication overuse headache. In fact, sinus or allergy problems do not cause a chronic daily headache; it is the medication used for the sinus symptoms or allergy. Stopping the overused medications brings a significant reduction in the frequency of headaches.
Q: Apart from chronic daily headache, are there other problems associated with medication overuse?
A: Yes. You may develop a dependence on symptomatic medication, and medications for preventing migraine may become less effective. If you are overusing a medication and consequently the associated migraine symptoms of nausea and sensitivity to light or sound are less severe and less frequent than during typical migraine, you may not be diagnosed with migraine and may therefore not receive appropriate treatment.
Q: Why do some drugs cause medication overuse headache?
A: Experts do not know why medication overuse headache develops in those who have migraine. Theories vary from a change in neurotransmitter function to a “rewiring” of the pain control system in the brain. What we do know is that by stopping the offending medication, daily headaches stop and migraine preventive medication is more effective.
Q: What should I do if I think my headache is due to medication overuse?
A: The first step to treating any headache problem is getting the right diagnosis so, if you have headaches that trouble you, you should see a doctor. Once you have been diagnosed with migraine, it is important that you avoid the overuse of any medication that could complicate your treatment. For those who are experiencing medication overuse headache, it is imperative to treat the underlying migraine, as well as the overuse headache. Suddenly stopping medications can cause withdrawal headaches unless you and your doctor plan ahead. Failure to maintain control of the headaches can convince you that the only way out is to return to using the pills that have complicated your problem. For the best results, see a doctor who is familiar with the treatment of medication overuse headache. Some individuals may require the expertise of a headache specialist. However, do not give up—migraine and headache disorders are treatable. No one should be told to just go home and live with the pain.
Q: Can a medication cause a headache that is not a rebound headache?
A: Yes, there are medications used for other health problems that may have headache as a side effect. and may trigger migraine attacks. The medications that are most likely to trigger migraine are those that widen blood vessels, such as those used for angina, high blood pressure, and sexual dysfunction. Some medications used for ulcer disease and certain antibiotics may aggravate migraine as well. Hormonal therapy with cyclical progestogen can trigger migraines too. If your migraine attacks increase in frequency after you start a new medication, or if you have difficulty controlling your migraine, you may need to investigate the possibility that another medication you are taking is interfering with your migraine control.

Medications that can cause medication overuse headache

Many different medications can be associated with medication overuse headache. Some of these are prescription, some over-the-counter (nonprescription), and some are considered natural herbal medications. Medications containing analgesics are the most common cause of medication overuse headache. These painkillers range from acetaminophen, found in nearly every over-the-counter medication, to very addictive opioids (narcotics).

  • Acetaminophen

  • Combinations of acetaminophen, aspirin, and caffeine

  • Combinations of acetaminophen or aspirin and butalbital plus caffeine, with or without codeine

  • All sinus/cold pills, nasal sprays, eye drops (unless pure steroid or pure antihistamine)

  • All opioid (narcotic) painkillers (codeine)

  • All sedatives (sleeping pills)

  • All antianxiety medications

  • All hypnotics (sleeping pills)

  • All muscle relaxants (except baclofen)

  • Herbal energy or diet pills

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