If you’re prone to migraines, overdoing it on certain medicines can create a headache … literally.
If you feel a migraine headache coming on, you may reach for medicine, such as ibuprofen or an acute migraine medication, to relieve your pain. If it made you feel better, you’ll likely keep it on hand to help with the next attack. However, if you take these medicines too often, it can backfire.
“There's a variety of reasons people sometimes take more than the recommended amount of medications to treat acute migraines. For some people, it can become an anxiety thing. The migraines can be so bad that when you feel anything coming on, you just run to take that acute treatment to turn it off,” says Sylvia Mohen, MD, neurologist in New York City.
Here’s the problem: If you do this too frequently, it can be a hard cycle to break.
What Is a Medication Overuse Headache?
“Medication overuse headache is actually classified as having 15 headache days or more for three months associated with overusing an acute migraine treatment. Really what it is is you're using the acute treatment so frequently that you're just having more headaches,” says Dr. Mohen.
In other words, those same medications that initially helped relieve your headache pain can actually trigger headaches if they are used too often. But why would pain medicine cause headaches to be worse? Research suggests that frequent pain medicine use can lower your threshold for experiencing pain, and reinforce the pathways that process pain.
Medications That May Cause Overuse Headaches
Certain migraine medications and stimulants are associated with medication overuse heachaches. These include:
- Pain-relievers, such as acetaminophen or NSAIDs like ibuprofen
- Combination pain relievers, which may have caffeine in them
- Triptans and ergotamines
- More than 200mg of caffeine per day, which is about 2 cups of coffee
It’s important to note that acute migraine medications are not the same as oral preventive migraine medicines, which should be taken daily. “The acute treatments are really trying to turn off the headache that you're experiencing right now, whereas the preventative medications are really preventing you from having headaches to begin with,” says Dr. Mohen.
Treating Medication Overuse Headaches
Medication overuse headaches may seem like a difficult cycle to break, but with your doctor’s help, you can find relief. “We do get people through these headaches and people do very well once they come off of the medications that are actually causing the problem,” says Dr. Mohen.
You can prevent migraine medication overuse headaches by understanding your prescription. Be sure to ask your doctor how often to take your acute migraine treatment, and what to do if your prescription isn’t effectively keeping your migraines at bay. Needing to rely on your acute treatment that often is a sign that it’s not the best fit for you.
Sylvia Mohen, MD, is a neurologist at New York Neurology Associates, P.C.
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Medication overuse headache is actually classified
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as having 15 headache days or more for three months
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associated with overusing an acute migraine treatment.
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It really, what it is is you're using the acute treatment
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so frequently that you're just having more headaches.
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There's a variety of reasons people sometimes take more
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than the recommended amount of medications
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to treat acute migraines.
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For some people, it can become an anxiety thing.
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The migraines can be so bad that when you feel
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anything coming on, you just run to take
that acute treatment
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to turn it off, and if you're doing that,
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say like 3 to 4 days a week,
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it may put you into a situation where your headaches
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just become more and more frequent.
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It's sort of like a negative feedback loop.
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There seem to be genetic factors actually associated
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with medication overuse headaches,
and they are
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more common in people with migraine
and tension-type headaches.
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The degree of disability of migraines alone, too,
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I think sometimes predisposes people to having
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that anxiety and nervousness that causes them
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to overuse the acute treatments.
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The acute treatments are really trying to turn off
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the headache that you're experiencing right now,
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whereas the preventative medications are really
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from having headaches to begin with.
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So medication overuse headaches are most often
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associated with the barbiturates and the opioids,
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which is why they're not recommended for the use
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for acute migraine treatments.
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The triptans and ergots are more intermediate.
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Triptans are worse than the ergots,
and actually NSAIDs,
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commonly as we see, NSAID overuse headaches actually
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have less tendency to cause overuse
than some of the other medications.
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I would tell somebody struggling
with medication overuse headaches
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that they're not alone,
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that it's pretty common,
and that it can be a little difficult to treat,
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and with medication overuse
you really do have to build trust
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with the patient because
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they've come to rely on this medication often
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as being the thing that helps them.
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We do get people through these headaches
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and people do very well once they come off
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of the medications that are actually causing the problem.
- Medication overuse headache. American Migraine Foundation. Accessed on August 13, 2020.
- Headache attributed to a substance or its withdrawal. IHS Classification ICHD-3. Accessed on August 13, 2020.
- Preventing and treating medication overuse headache. Pain Rep. 2017 Jul. Accessed on August 13, 2020.
- Medication overuse headache: Treatment and prognosis. UpToDate. Accessed on August 13, 2020.