Enough is Enough: Rebound Headaches

News anchors, journalists and medical websites have warned that “painkillers might be causing your pain!” too many times to count. OK, OK, rebound headaches are nasty; so are chronic daily headaches and migraines. I want to know how much is too much. Not vague amounts, but clear, precise doses.

In comes the conflicting advice. One doctor said to rotate Imitrex, Migranal and Advil every three days to avoid rebounds. Another said that it’s perfectly fine to take a triptan a couple days a week and an OTC painkiller another few days. Of course, no doctor knew just how much Advil I took because I was afraid to admit the amount to myself, much less say it out loud.

When dignity took a backseat to pain relief, I stopped the painkillers. Four years later, I can barely remember how much better I felt when I took occasional painkillers. I often forget that it’s even an option. But I do remember my headache specialist telling me that the goal of my treatment is to make me feel like I do when I take Advil*. Lately, the forbidden drug has started calling my name.

Because my headache specialist, who I think is terrific, relies on the International Headache Association’s standards, I’ll do the same. IHS’s bottom line is that rebounds are likely if you take painkillers or migraine abortants more than once or twice a week or more than 10 times a month. As you well know, nothing is one size fits all, but these are good guidelines.

Think you might be in rebound? Here are some frequently prescribed meds that can cause rebound headaches. You’ll be miserable if you stop them cold turkey, so get your doc’s advice first.

Triptans: Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig

Ergots: Cafergot, D.H.E. 45, Migranal, Sansert

OTC Painkillers: Acetaminophen (Tylenol, Excedrin, Vanquish), Asprin (Bayer, Bufferin), Ibuprofen (Advil, Motrin), Naproxen Sodium (Aleve)

Prescription NSAIDs: Indomethacin (Indocin), Ketorolac Tromethamine (Toradol), Naproxen Sodium (Anaprox, Naprelan, Naprosyn), Piroxicam (Feldene)

Opioids: Fentanyl (Duragesic, Actiq), Hydrocodone (Vicodin, Lortab, Lorcet, Norco), Morphine (MSIR, MS Contin, Oramorph), Oxycodone (Roxicodone, OxyContin, OxyFast, OxyIR)

The scariest part about stopping the meds is that your headaches might not change or may even worsen.The underlying condition that prompted you to take them in the first place is probably still there. Even if you don’t get immediate relief, your headaches may be easier to treat in the long run with fewer drugs getting in the way. And your kidneys will thank you.

*Advil doesn’t get rid of my headaches, but it sometimes reduces the severity of the pain. For me, feeling “much better” is having pain that’s below threshold that would keep me in bed.

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26 Responses to “Enough is Enough: Rebound Headaches”

  1. marisa Says:

    Wow. Also scary – I’ve been on a majority of the migraine/headache drugs listed above, not to mention a bunch that aren’t. And I’d bet that anyone who’s struggled with migraines for very long has, too.

  2. jessipo Says:

    Wow! I can’t believe Advil works for you. I started out with the OTC pk’s like Advil and Ibuprofen, but they couldn’t touch the pain. Even the pk’s I’m on now, barely touch it. I’m glad those otc’s work for you. What a gift! 🙂

  3. ALAN V Says:

    THANKS TO PEOPLE LIKE YOU. I SEE I AM NOT ALONE. I’M 48,BEEN A MIGRIANER SINCE 1990. IMITREX IS MY WONDER DRUG. CURRENTLY MY LONGEST BATTLE OF 90 DAYS. ALL MY DOCTORS BELIEVE I HAVE REBOUNDS. THEY ARE STOPPING MY PRESCRIPTION. SO I HAVE NO CHOICE BUT TO TAKE A DAY OFF WORK AND BATTLE THIS DEMON. SO HERE I AM ALONE AND WAITING. BATTLED IT FOR 1 HOUR LAST NIGHT AND I JUST WAS NOT GETTING ANY RELIEF. SO I TOOK MY LAST SHOT OF IMITREX. I REALLY DON’T NO WHAT TO DO. THANKS FOR THE HELP.

  4. Leela1210 Says:

    I need help…. I have been taking Hydrocodone for almost 2 years now (on and off) I recently had back surgery and have been taking the PK’s on an (what seems like) hourly basis… I have recently (3days) been experiencing these horrifying headaches when the PK’s wear off….. I can not keep my eyes open… My head hurts sooooo bad, I feel like I am going to die…. Is this a rebound headache?? What can I do to get rid of it? I have tried excedrin (tension) Mobic, and Cephadyn…. Nothing is working… I have had this headache for 3 days now, and I am a single mother of a 2 year old… Can anyone help???

    *********
    It definitely sounds like a rebound headache to me. Taking other painkillers will likely keep the problem going. Some doctors will prescribe something to make the withdrawal easier, but I’m not sure what that is. I think that a lot of people just stop it cold turkey and go through some nasty withdrawal symptoms.

    I know that’s not much help. Anyone else have suggestions?

    K

  5. Kathi Says:

    I have had migraines since I was a teenager, but in the last year (I turned 40 in August) they have been increasing in frequency, pain, and duration. I was on imitrex, but it stopped working for me. Over the years I have been on:
    Caffergot
    Darvocet
    Imitrex
    Zomig
    Maxalt
    Emerge
    Topomax
    Flova
    Relpax (current one)
    Vicodin
    Zoloft
    Percocet
    Inderall
    Depakote(current one)
    Naproxin (allergic)
    Fioricet (allergic)

    The Relpax isn’t working and he has me taking 2 pills together with Reglan for my stomach which also doesn’t work. The headache comes back after about an hour and my stomach feels like crap for the whole 12 hour dose. These meds are just the ones I can remember.

    Now on top of this problem, I have sinus issues and am due to have surgery on April 26th.

    The only thing that worked for me in the last 4 months or so is Percocet, but the Dr. doesnt like to prescribe them very often. Honestly, I don’t like taking them either, but I don’t like not being able to function 15+ days a month either.

    *********
    I’m sorry you suffer with this too. Good luck with your surgery. I hope it helps you tremendously. Let me know how it goes.

    K

  6. Shannon Says:

    It would be nice if doctors could agree on which meds cause rebound. Last week after a migraine that dragged on for 5 days I contacted my doctor to get her perspective on which NSAIDS cause rebound. She said that NSAIDS don’t cause rebound very often, and in her opinion the biggest problems are caffeine and opiates.

    I gave up triptans because I’d read they were a significant source of rebound, and this was consistent with my experience. The only drug I’m taking right now as a preventative is a low dose of Amitriptyline, which I know isn’t sufficient because I still need to use Relafen (an NSAID) and/or Valium about 2-5 days a week to stop a headache from escalating into a migraine.

    I had the least amount of migraines several years ago when I took 20 mg of Feldene once a day for a little over a year. I didn’t know it was Feldene that was keeping the migraines at bay. I’d started taking the drug to help with another chronic pain condition. I thought something had finally shifted and I’d outgrown my migraines.

    And then one day I started getting horrific upper abdominal pain. My doctor was convinced the Feldene had given me an ulcer, but the test results came back negative. I’d been taking the Feldene with Cytotec to protect my stomach so it didn’t surprise me that I didn’t have an ulcer. However, it did become clear to me that immediately after I’d take the drug that gawd awful abdominal pain would start up. So I stopped the Feldene–and within a few weeks the migraines returned. So much for my delusion that I’d outgrown them.

    Even though I stopped the Feldene the pain didn’t stop, it was just further aggravated by the drug. It took 3 months of testing to finally be diagnosed with non-erosive GERD, and now I need to take Prilosec twice a day to keep that condition under control.

    This was a disappointing experience. Feldene was such a wonder drug for me for a year, and I suffered no rebound while taking it.

  7. Fred Says:

    I started taking oxycontin for a bladder disease that was very painful. The pain mgmt Dr. kept me on the drug for over 4 years. Now I have constant headaches and am afraid to take more nsaids because of the rebound. I have an imitrex and am going to try it. Let’s see if it works. I am told these oxycontin headaches can last up to a year. I have been off the drug for not quite 2 months.

    ********
    I’m sorry you’re still suffering. A year seems like a long time to have rebound headaches. I hope you find something that helps.

    Take care of yourself.

    K

  8. Kathi Says:

    I have since been put onto Midrin which seems to work about 75% of the time. From what I understand it is an older drug, but so far it is more successful than anything I have taken in the past 2 years.

    *********
    That’s terrific! My husband has tried all the new drugs, but Midrin is the best for him too.

    K

  9. jonathan brook Says:

    Ice packs on my eyes and neck; scrubbing my scalp; massage…in concert with drug therapy…has helped.

    ********
    I’m so glad you’ve found something that helps. Take care of yourself.

    K

  10. L Says:

    HI, I WAS PUT ON PAIN KILLERS FOR OTHER REASONS AS WELL. PERCOCET, TYLOX, VICODIN, NORCO, LORTAB AND ALL THAT STUFF . BUT EVERYTIME I TAKE ONE, AFTER THEY START TO WEAR OFF, NOT ONLY DO THEY MAKE ME FEEL AWEFUL, I ALSO GET A VERY BAD HEADACHE. I HAVE BEEN TAKING THESE PAIN KILLERS FOR OVER A YEAR NOW. AND I THINK I AM GOING TO COME OFF OF THEM. THEY DO CAUSE REBOUND HEADACHES. I TALKED WITH A DOCTOR AT THE E.R. ONE DAY AND HE SAID THAT THEY DO CAUSE REBOUND HEADACHES. MY MOM IS A NURSE AND ALSO HAS MIGRAINES. SHE SAID THEY CAUSE HER TO HAVE REBOUND HEADACHES. I THINK THE REBOUNDS ARE THE WORST. WHEN I GET THEM, I ALSO FEEL LIKE I’M DYING. IT DOESN’T JUST EFFECT MY HEADACHE, BUT MAKES ME FEEL BAD ALL OVER. DON’T THINK THE PAIN MEDS ARE WORTH IT. I HOPE EVERYONE FEELS BETTER SOON :O) LR

    *********
    Best of luck breaking your rebound headache cycle.

    K

  11. Sue L Says:

    How long do nsaids stay in your system? I have had bad headaches for the past 2 or 3 years that I’ve treated with ibuprofen. If I take it, I avoid the headaches. The best description of my headaches are the cluster type: pain always on the left side, centered around my sinuses, often making my nose on that side clog up. They last 30-45 minutes & recur about every 8-10 hours, but not if I take nsaids–ibuprofen works best. I’ve tried cutting out AM coffee and the PM glass of red wine with no change. I saw a chiropractor and tried acupuncture.No help. I bought a capsacin (pepper) based nasal spray and am trying that.
    My neck and shoulders always carry tension. Can that cause a pinched nerve or something else that could trigger the headaches? I’m so tired of taking the pills so I quit them yesterday and am suffering. I don’t know what else to do. Any suggestions?

    *********
    I don’t know how long it takes for meds to get out of your system. I think the rule of thumb is three to four weeks, but it could be less and it could be more.

    Have you considered seeing an MD? Knowing what type of headaches you’re having could help you, even if you don’t want to take any meds for them.

    Sorry I couldn’t be more helpful. Let me know if there’s anything else I can do.

    Take care,
    K

  12. Kendra Says:

    I read a book on Migraines written by a neurologist who said NSAIDS DON’t cause rebounds! I am so confused. I’ve had migraines for years, am 47 and getting more chronic. Here I am taking Advil daily thinking it is safe! Great. Guess I need to withdraw and go through pain like I did giving up caffeine. The book is Heal Your Headache, the 1.2.3 program by David Buchholz, M.D. Any chance I’ll be free after menopause? What choices do I have if I am only allowed Advil a couple of times a week? Isn’t it better to abort than keep the brain in an over-excited state? Won’t it do damage?

    *********
    I saw that in Heal Your Headache too, but everything else I’ve ever read and been told by doctors is that they NSAIDs do cause rebound headaches.

    There are a lot of other treatments for migraine, both abortive and preventive, so you still have many options without taking NSAIDs very often. It’s definitely something to talk to your doctor about. Also, you may be in a rebound cycle right now so that not taking NSAIDs may make your headaches better.

    Some women do stop having migraines after menopause, but not all do. The Women’s Migraine Survival Guide by Dr. Christina Peterson is full of great information about headaches, hormones and menopause. It may help answer some of your questions.

    I’m not sure about the brain being in an over-excited state or if it can cause damage — a neurologist is probably the only one who can answer that question. I know that headaches are harder to treat the longer a patient has had them. It’s like the brain learns to be in pain and has trouble un-learning it.

    I hope this helps. Let me know if I can help with anything else.

    K

  13. Robin Snyder Says:

    I have had cluster headaches for 30 years. They have become increasing worse. I have tried every drug made. Most recently, Lyrica, and Cymbalta, neither worked for me. I take a combination of Zomig and Exceedrin and get the most relief from them. However, my doctor believes I have rebound headaches from the exceedrin I take daily. I have tried to get off it, but my headaches become out of control. Is there any way of successfully weaning ones self from the Exceedrin?

    ********
    It’s much easier to slowly wean yourself off medications than it is to stop them cold turkey. Your doctor should be able to give you a schedule to follow for decreasing the medication slowly — it depends on how much you’re taking and what your dose is.

    Best of luck.

    Kerrie

  14. Kendra Says:

    I am doing so much better since my last post. I was unable to take Topamax even at 50 mg because my loss of appetite was severe, and friends and my brother, were getting kidney stones. (am told that is the worst pain EVER, more than childbirth!)Plus, the other side effects were bad. I have weaned myself, slowly, off of daily advil, been diligent to the point of madness with the migraine diet (it’s not so bad after the initial “woe is me” phase, esp at the Superbowl party!), and am on a low dose of Pamelor (nortriptyline). ( tried Amyltriptiline, Elavil, but heart racing was a prob and Pamelor has worked better on my headaches)I still have vague pain around menstruation, and ovulation, but my need for abortives has become less, (2x mo) and I haven’t had an aura now since Jan 1st. I was getting those on a regular basis. I also have prescription Phenergan suppositories that help with the nausea, and I use even w/out a major migraine, because you can still get migraine symptoms without the major headache) I am cautiously optimistic, but very encouraged. Even though Dr. Buchholz’ book didn’t indicate advil as a potential rebound causative, the rest of the book helped me a hundrefold. So has your blog. Thank you so much and blessings and Godspeed to fellow sufferers. Thanks again!

    *********
    What great news! I hope you continue to feel better.

    Kerrie

  15. Nina Says:

    I’ve been taking hydrocodone/apap for herniated disk for the last 3 or 4 months, and all of a sudden I’m realizing that the migraines that I thought were a thing of the past are with me 4 or 5 days of the week. It’s the painkillers isn’t it? I never even heard of rebound headaches from this medication. Imitrex helps but I take it way too much. Guess I need to stop the meds….thanks for the helpful comments

    ********
    The painkillers could definitely be the culprit. Don’t get discouraged if you don’t notice a change for a while — it can take two months to get the rebound-causing drugs out of your system.

    Take care of yourself.

    Kerrie

  16. Shawn Says:

    Meds Taken I’m 22 years old
    Adderall for 9 years works well still no problem except need a benzo to call my CNS

    Ritalin for 2 years
    Lamictal I hate you
    Risperdal sleep but not my preference
    Straterra sucks for ADHD
    Abilify I’m awake, then tired no good
    Trazadone insomia and headaches
    Amitriptyline insomnia and neuropathy , no good
    seroquel insomnia and horrible nightmares
    Ropinorole I don’t have RLS, symtoms are similar

    Klonopin great for headaches
    Soma short term pain help headaches
    Vicodin short term pain, give headaches if I don’t have anticonvulsant to take bfore hand

    Lexapro depresion baby stuff
    Zyprexa insomia
    Symbyax insomnia
    Trileptal moderate success for headaches
    Xanax (iiegally bought, but at a dose just enough to get rid of headaches )
    Gabapentin no real relief

    With the exception of Klonpin and Adderall and never had dehabilitating headaches till after taking Lamictal for 2yrs. With no meds that the appropriate certain pharmacokentics take away the chronic headaches , Im uaable to workout, concetrate , ( one alcoholic beverage in the leave hunch over the next morning with the shakes for example ) I quit taking Adderall my 1st semester college to see how would and I did well, but began havin mood swings…this led to various meds I was prescibed for Bpolar 2.. I now believe i was withdrawals after Adderall for long. thats my story

    ********
    Thanks for sharing your story, Shawn. I’m sorry that you’re suffering so much. Hang in there!

    Kerrie

  17. Stephanie Foley Says:

    My daughter age 10 has had only a couple migraines, (these we’ve just figured out were incorrectly diagnosed as sinus infections_. A month ago one started and we ended up giving her ibuprofen (2 – 6 a day) for 3 weeks straight. As we tried to figure out what was going on with her (trips to the ER, spinal tap, CT scan, homeopath, allergist, accupuncturist, etc.) we finally ended up at the neurologist who diagnosed rebound headache. She is now still suffering tremendously from am – pm. Got her Xanax today which relaxed her a bit, but she’s crying now. Does anyone have experience with HOW LONG THIS WILL GO ON?? We stopped ibuprofen 4 days ago. The neurologist told us 4 – 8 weeks. This is insane to me. Any thoughts. Thanks.

    ********
    I’m so sorry to hear your daughter is suffering so much. I’m sure it is really stressful for you too.

    Unfortunately, rebound headaches can last eight weeks. Usually it happens more quickly than that, but there’s no way to predict how long it will be.

    Kerrie

  18. Michelle Says:

    I’ve always had tension headaches growing up. But they stopped for a number of years and would come and go..they were never drastic. ABout 3 months ago i had some major dental work with my wisdom teeth & a root canal..I also suffer from TMJ which i wear a mouth guard for. The dentist put me on Motrin for 3 weeks, taking up to 1600 mgs a day. I went on several rounds of antibiotics as well. The nausea began after the antibiotics and never subsided since. I still suffer from major headaches now that im not even taking any motrin. I have major eye pain and the pain is all over my head including my neck and shoulders. I went to a neurologist, she prescribed me prednisone, fioricet, relpax..NONE of which worked. I even went to the opthomologist who also said she saw nothing wrong with me. I went for an MRI ysterday and i am awaiting the results.
    Is there any way this could just all be rebound headaches?

    ********
    There’s definitely a chance of it. Did you talk to your doctor about the possibility?

    Kerrie

  19. Susan Says:

    Help me? I woke up with a severe headache all over my head into my ears. All the through my neck & shoulders??? Took advil cold & Sinus, then a Fiorcet, then a aleve w/800 motrin w/aleve. I really don’t like takin Imitrez 100mg to much. They kinda give me mild pains in my chest. Any Solutions please help me…

  20. Martha Says:

    I stopped taking daily OTC meds for headaches on January 1. I’ve had headaches related to food allergies every day for 15 years, as well as fibromyalgia. Allergy elimination treatment by my chiropractor helped get FM under control, but not the headaches. I finally realized they were rebound headaches, thus stopping meds. The frustrating part is that about 3 days out of the week, I finally feel great. No headache. Then comes 4 days of ongoing pain. This after 3 months of no pain meds.

    What I find is that my head is very sensitive to triggers – mostly food related, and things that I cannot identify. I’ve already eliminated most of the common triggers. I was advised to shop the “outside walls” of the grocery store – where the foods have no additives. I think there is validity to this. I’m about to give up spices and seasonings as well.

    I don’t know how long the sensitivity and rebound will last – hopefully it is not tied to the length of time I took daily excedrin (15 years). However, there are those 3 or more days a week without pain – and I see a light at the end of this very long tunnel.

    Thank you for your blog. It helps to see what others are experiencing as well. God bless you

  21. Linda Says:

    I can’t believe how many others are like me! My migraines have become so frequent within the last few years that I don’t tell anyone for fear of sounding like a Hypochondric. The only complete and lasting relief I ever had was during the last 5 months of my pregnancy. (I’m not pregnant now.)

    I’m taking Relpax 40 mg. and it works 90% of the time. My problem is, the migraines have been coming back daily at almost the same time every night. Maybe due to allergies? (It’s Spring and EVERYTHING is in bloom right now.) I’m considering going to an allergy doctor to find out what I’m allergic to, and see if I can get some type of shot to avoid the allergic reactions (that may cause my sinus problems), then trigger migrains. Have you ever heard of that working for anyone? After reading your blog, however, I now wonder if rebound is my main problem.

  22. Pat Says:

    I’ve just read a wonderful book called “Heal Your Headache: The 1,2,3 Program” by Dr.David Buchholz, MD. You can read the reviews on Amazon.com. People rave about it. Dr. Buchholz is a neurologist at Johns Hopkins and has been dealing with people with headaches for years. He seems to see amazing results with his plan. It’s based on three things: 1) getting off all medication, 2) diet (a major trigger) and 3)safe pain meds (only if necessary and he states most people don’t need this step). I’ve been following the book for almost three weeks now and I have great hope. It can take a couple of months to begin to see the results but people say it truly works. Dr. Buchholz also states that he believes almost all head and neck pain is actually a form of migraine (including so-called tension and sinus headaches). I recommend this book.

  23. christy Says:

    I was lucky to have very few headaches until about 4 years ago, when I was 38. I started having migraines once every other month until I contracted meningitis. Unfortunately, that triggered daily migraines. I had no idea there were so many other people that have daily migraines, as well. This site has helped me find some hope that maybe something will help. It’s so depressing to wake up every day and go to bed every night with something that hurts so much. As scary as it is I am going to try to cut my meds (hydrocodone & advil) to see if maybe I’m suffering a rebound which is making my underlying problem worse. Best of luck to all of us getting some relief.

  24. John E. Says:

    I have suffered from cluster headaches for 35 years. It wasn’t until 2001 that I started taking Imitrex. My cycles would usually be every other year and last about 4 weeks. I was taking Imitrex (50mg) at least 4 times per day. Imitrex really worked for me but I started to notice that my headaches would come back right after the pill wore off. When I wasn’t on Imitrex, the headache would come at night, last 45′, then go away for about 4-5 hours.
    I went into remission in 2004 until now. Started taking Imitrex again but noticed that after about two weeks (at least 40 pills) they were not working as well.
    My cycle ended and now I was getting these dull headaches that would last all day, EVERY DAY. I would take an Imitrex which would work, but 6 hours later, the pain returned.
    I now believe these to be rebound headaches. I tried Advil believing that these were on the “safe” list, but have now discovered they are not. So……….I will try to go Cold Turkey and hopefully these will go away.

  25. Melissa Says:

    Linda – it sounds like yours are rebound headaches caused by the Relpax. Try taking Claritin D daily to see if that broke the cycle. It broke mine but after three months my migraines came back and I made the mistake of taking Relpax again (40mg)and I got the rebound headaches back. They are more like transformed headaches and they end up becoming migraines. They start in the back of my head and go to my forehead/temples/cheeks/neck/sholders and end up making me nauseated. Nothing kicks them other than what they are asking for (Relpax)…

  26. josemr Says:

    I have been suffering from daily headaches for 10 years. I used to take excedrin which was successful,but Recently my headaches are worsening that even triptans recommended to me by my Dr. doesnt work. I have read about dehydroergotamine as the good headache reliever helping withdrawal to daily medications for rebound headaches. Please advise me.


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