Medication Overuse Headache

Medication Overuse Headache

For a person with chronic headache the use of pain relief medications such as Tylenol, Advil, Motrin, Aleve, and Excedrin Migraine can have risks.

Because they are sold over the counter many people don’t consider them “medications.”  Last week I saw a patient who was taking large quantities of these medications for her several-times-a-week headache.  When I suggested that she take a daily prescription drug for prevention her reaction was “I don’t want to take medication.” 

So the first thing in managing headache medications is to recognize that these are medications. (Here we will refer to acetaminophen and non-steroidal anti-inflammatory medications as “NSAIDs.”)   There are medical risks to each of them, including rare but severe damage to heart, kidneys, liver, and stomach.  Often the side effects come without warning in a previously healthy person.   When used sparingly and infrequently, the risks are minimal. 

Another mental habit I encounter is that the person thinks the use of an NSAID doesn’t “count” if it is taken for a different kind of pain.  So if a person is taking Aleve for arthritis and Advil for headache, the thinking goes, they can be calculated separately.  But your internal organs don’t know what you are taking it for—they have to process everything you take.

The problem with chronic headache is that the person usually can get a few hours’ relief by taking one or two of these pills.  But there can be a vicious cycle in which the medication itself, after a couple of hours, causes a “rebound” headache.  So the person takes more over-the-counter medications, and the cycle repeats. 

How to break the cycle?  It is not dangerous to go “cold turkey,” although it might be uncomfortable for a few days.  In my practice that usually works better than trying to decrease gradually.  It’s best to start when you have a light schedule.  Hydrate generously; allow yourself plenty of sleep and light exercise.   Definitely avoid any food, drink or activity that is likely to trigger your headache. 

If you are having headaches more than once a week you should be evaluated by a doctor to rule out an underlying cause.  A doctor experienced in treating chronic headache can give you a plan to manage your headache.  You are likely to benefit from a daily preventive medication.  There are many medications that are beneficial and your doctor can choose the one that is best for you.  It can be a good idea to start the preventive medication before you get off your NSAIDs but it can take several weeks for the preventive to show any benefit. 

But don’t delay!

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