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When painkillers trigger pain: medication-overuse headache

Paradoxical but true: medications you take for headache relief can themselves trigger headaches. A nervous system control mechanism is behind this phenomenon. Taking painkillers regularly and for a long time makes the nervous system more sensitive to pain – which is the opposite of what you want.

Medication overuse headache happens when you take pain medication too often

This is your body’s attempt to restore the original, 'normal' level of pain perception – because one of the functions of pain is to warn and protect us, and your body wants to preserve that important capability. When you stop taking pain medicines after prolonged regular use, it can trigger an agonizing rebound headache. Many people react by taking more painkillers, and a vicious cycle begins. Pain and medication use worsen each other over time, eventually resulting in medication overuse headache

The 10-20 rule

The good news is... you can prevent medication overuse headache by following one basic rule. In any one-month period, do not take painkillers for migraine and headache relief on more than 10 days. Regardless of dose. Use no pain medication whatsoever on the other 20 days of the month.

To apply this rule, you need to keep a close eye on your medication use. Log each dose in your planner or drug diary (have a look here; the app is ideal). You can see right away whether you’re in the safe zone in a given period or need to take extra care. Sticking to the 10-20 rule stops your body from lowering its pain barrier and ensures that your headache remedies remain effective.

Combat medication overuse headache with a drug holiday

If these precautions come too late and you already have a medication overuse headache, you need medical help to get your pain regulation system back on track. Your healthcare team will probably recommend a ‘drug holiday’ (a cute name for a drug-free period), ideally as an inpatient in a specialist clinic where you will have continuous access to the best medical care. The treatment takes about two weeks. You may receive special medications to help refill your depleted stores of neurotransmitters. Another aim is to empower you to manage your headaches without drugs in the future.

Hit your headache where it hurts

If you’re battling medication overuse headache, a drug holiday under medical support and supervision is hugely beneficial. Re-setting your pain regulation system will give you back control over your headache and help you get your life back. Ideally, you will also receive education and coaching on how to get the most out of your meds in future by using the most effective regimen to target your headache.

The safe way: prevention without drugs

Lifestyle modification should always take center stage in headache prevention. Integrating good habits into your life will help you reduce your medication use to your personal minimum effective dose. Responsibly reducing your use of headache medications should be your top priority for several reasons. Not getting caught in the vicious cycle of pain and medication in the first place will spare you the distressing effects of medication overuse headache and the pain of withdrawal. And you get to avoid the other side effects of taking painkillers, some of which can be very serious.

  • Chanraud S, Di Scala G, Dilharreguy B, Schoenen J, Allard M, Radat F. Brain functional connectivity and morphology changes in medication-overuse headache: Clue for dependence-related processes? Cephalalgia. 2014 Jul;34(8):605-15. doi: 10.1177/0333102413519514. Epub 2014 Jan 21.

    Diener HC, Holle D, Dresler T, Gaul C. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. Dtsch Arztebl Int. 2018 Jun 1;115(22):365-370. doi: 10.3238/arztebl.2018.0365.

    Diener HC, Limmroth V. Medication-overuse headache: a worldwide problem. Lancet Neurol. 2004

    Göbel H. Die Kopfschmerzen. Berlin, Heidelberg 2012

    Hagen K, Albretsen C, Vilming ST, Salvesen R, Grønning M, Helde G, Gravdahl G, Zwart JA, Stovner LJ. A 4-year follow-up of patients with medication-overuse headache previously included in a randomized multicentre study. J Headache Pain. 2011 Jun;12(3):315-22. doi: 10.1007/s10194-010-0285-1. Epub 2011 Jan 5.

    Hagen K, Linde M, Steiner TJ, Stovner LJ, Zwart JA. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies. Pain. 2012 Jan;153(1):56-61. doi: 10.1016/j.pain.2011.08.018. Epub 2011 Oct 22.

    Kudrow L. Paradoxical effects of frequent analgesic use. Adv Neurol. 1982; 33:335-41. Aug;3(8):475-83. Review.

    Radat F, Chanraud S, Di Scala G, Dousset V, Allard M. Psychological and neuropsychological correlates of dependence-related behaviour in medication overuse headaches: a one year follow-up study. J Headache Pain. 2013 Jul 4;14:59. doi: 10.1186/1129-2377-14-59.

    Srikiatkhachorn A, le Grand SM, Supornsilpchai W, Storer RJ. Pathophysiology of medication overuse headache--an update. Headache. 2014 Jan;54(1):204-10. doi: 10.1111/head.12224. Epub 2013 Oct 3. Review.

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