A desire to take medication is, perhaps, the great feature which distinguishes man from the other animals. -- Sir William Osler's dictum, 1891.
Over-the-counter pain medications work well when used occasionally. But did you know that most of them produce a new type of headache and cause an escalation of the headache symptoms when used frequently? For example, taking more than three aspirin or other medications 2-3 times per week can turn intermittent headaches into chronic and daily headaches. This means that headache sufferers who give up daily painkillers may actually feel better, not worse. As an added bonus, when people are no longer taking the daily painkillers, then preventive medications will work much better.
Rebound Headache, aka Analgesic Headache or Medication-Induced Headache
Chiropractors know that our patients with a proneness to headache may get into a pattern of having daily or almost daily headaches. For some, the headache attacks may become so frequent that they finally blend together with no clear cut beginning or ending of individual episodes. Taking headache relief medications too frequently may even make debilitating headaches more likely to strike on a daily basis.
Daily or almost daily (>2-3 times per week) use of even such over-the-counter medications as aspirin, acetaminophen and ibuprofen (or more commonly, combination sedatives/painkillers) is believed to interfere with the brain centers that regulate the flow of pain messages into the nervous system. In other words, there is a worsening of the headache disorder. This means that even if the patient is taking only over-the-counter painkillers on a daily or almost daily basis, they must stop until the body's own pain fighting mechanisms recover.
Everyone of us has a system in the brain to block pain. Burn sufferers know that the pain can be very intense. However, after a short while the pain starts to lessen. The body's natural pain-blocking system (the endogenous opiates such as endorphins) kicks in to relieve the pain. But the daily use of painkillers seems to interfere with this process and can lead to rebound headache (aka medication-induced headache or analgesic headache).
Unlike other headache disorders, rebound headache has come to be recognized only recently. Rebound headache is a condition of daily or near daily headache that develops in patients who have an underlying primary headache disorder, most commonly cervicogenic, migraine or tension-type headaches. Rebound headache generally has the following clinical characteristics:
The drugs most often implicated in rebound headache are:
Once rebound headache has occurred, up to 80% of patients will have their condition resolve simply by discontinuing usage of the offending drug. Depending on the pharmaceutical agent causing rebound headache, the weaning-off process may vary. When ergots are the cause, it may be necessary to refer to a neurologist specializing in headaches and medication withdrawal. The worst withdrawal process is with the patient who has been taking butalbital or other barbiturates daily or near daily. The patient will need a gradual withdrawal program to prevent potentially serious withdrawal reactions. Aspirin, acetaminophen and caffeine can be discontinued suddenly, but the patient can expect a worsening of the rebound headache over the next several days, with peak severity in the first week or so, followed by a gradual lessening for up to three months.
Keep in mind that the patient will be left with the original underlying primary headache disorder. Make sure the patient realizes this before undertaking a program of either a sudden or gradual withdrawal of the offending medication. You and the patient will need time to evaluate the benefit of discontinuation.
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Darryl Curl, DDS, DC
Norco, California
doc_curl@ix.netcom.com
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