Symptoms of Rebound Headache
How to Make a Diagnosis of Rebound Headache
The Causes of Rebound Headache
Treatments for Rebound Headache
Rebound Headache Websites
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daily or nearly daily headache |
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pain on both sides of the head |
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pressing/tightening quality ("like a tight belt
around my head") |
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perhaps a mild degree of photophobia (sensitivity
to light) or phonophobia (sensitivity to sound) |
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tight and tender neck and shoulder muscles |
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the patient is regularly taking symptomatic/abortive
pain medication |
It is important to realize that Rebound Headache is a SYNDROME and is
NOT one particular type of headache that a patient suffers.
Rebound headache most often develops in a migraine patient.
Typically, the migraine headaches gradually become more and more frequent
over several months with a gradual change in the type of headache: The
migraine headache happens less often and is replaced by a tension-type
headache, which becomes a daily occurence.
A common scenario in rebound headache patients is the following:
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for some reason (sometimes increased stress), the
migraine worsens; |
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the patient ingests more and more of their symptomatic/abortive
migraine headache medication; |
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eventually, the patient's medication becomes less
and less effective; |
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gradually, a daily or near daily tension-type headache
develops often accompanied by periodic, severe migraine headache. |
Abnormalities in the body that cause rebound headache are not known. Up
to 40-70% of patients seeking care at headache or pain clinics are thought
to be suffering from this syndrome. It probably is a rather common problem,
but it is under-recognized by doctors.
Many headache specialists believe that any abortive/symptomatic headache
medication can cause rebound headache; the most common culprits are
actually the over-the-counter medications!
The number of times a person with a history of migraine can ingest symptomatic/abortive
medication is not clear. Many authorities now suggest that migraine patients
take no more than a total of 10 doses of symptomatic/abortive medication
per month. Others allow more but become concerned about rebound when abortive
therapy is needed more than a few times per week.
Stop the Culprit Drug
If patients with rebound headache stop taking the drug(s) that are causing
the syndrome, in 4-8 weeks 80% note dramatic improvement -- without doing
anything else! However, for many patients, the initial few weeks may result
in a worsening of their headache.
If the culprit medication is not stopped, additional treatments
often will have very limited benefit. Studies have shown that
a prophylactic headache medication often will not have a beneficial anti-headache
effect when given to a patient that is rebounding. Therefore, when a rebound
headache patient tells the doctor that he/she "has tried every headache
medication known to man," more likely than not the prophylactic medications
were prescribed while the patient was in the rebound cycle, and thus the
drugs were not given an adequate drug trial.
Prophylactic Headache Medication
In addition to stopping the symptomatic/abortive drugs, some patients
may benefit from addition of a prophylactic medication, such as an antidepressant.
Stress Management
An important element in treating rebound headache is helping the patient
rid him/herself of the knee-jerk reaction to take a medication at the
first sign of head pain. Techniques such as relaxation, imagery, and biofeedback
can be helpful.
Biofeedback
Biofeedback may be an effective treatment for rebound headache.
Physical Therapy
Aerobic conditioning, neck and shoulder muscle stretches, craniosacral
manipulation, and massage may help.
Dietary Alterations
In some individuals with migraine, certain foods may trigger an attack.
These foods include alcohol, chocolate, coffee, foods that contain MSG
(monosodium glutamate) and tyramine-containing foods. Patients vary in
their response to foods, and it is not necessary to recommend that all
migraine patients stop eating potential triggering foods. Patients should
become aware of the foods that trigger their headaches and avoid these.
Headache/Pain Clinic Treatment
Rebound headache patients are often difficult to treat and require a multidisciplinary
approach, including strict medication management, stress management training,
and physical therapy modalities, all of which can be provided in a headache
or pain clinic.
Analgesic Rebound Headaches: Jnl of Family Practice
Headache, Migraine: eMedicine
Headache Disorders - Rebound Migraine: FamilyPracticeNotebook.com
Rebound Headaches: WebMD
See our
Treatments or
Mind-Body pages.
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