What is medication overuse?
Acute medications are those medications that you take at the time the headache is occurring. People who have frequent headaches, who take acute medications on a regular basis, could be making their headaches worse, leading to more headaches. These headaches are known as medication overuse headaches.
Medication overuse headache is the most common headache type seen in headache clinics. There are limits on the amount of acute medications a person can take to treat their migraine, without causing more headaches as a result. The limits are:
• Do not use simple painkillers like anti-inflammatories, such as Ibuprofen, Naproxen, or acetaminophen (Tylenol) for more than 15 days a month
• Do not use stronger painkillers such as opioids, like morphone or codeine, combination of painkillers, like acetaminophen with caffeine, or triptans, like sumitriptan for more than 10 days a month
Sometimes people go through periods where their migraine headaches are particularly bad and they may exceed the limits as outlined above. If these periods are short (less than 3 months) then they likely will not develop medication overuse headaches. This is the particularly challenging part of managing headache pain, since treating the pain with medications, leads to more headaches, which leads to more medication, and so on, like a slippery slope. If you are consistently going over the limits, you may need help from your doctor to come up with a plan to start tapering of these medications.
Some common signs that you may be taking too much medication are:
• Your headaches are becoming more frequent and more difficult to treat
• If you are taking a preventative medication, it is no longer working
• You need more medication to treat the headache
The theory behind why people get medication overuse headache is that frequent use of pain medication can actually lower your pain threshold leading the pain pathways to produce more pain. For most people with medication overuse headaches, nothing will help with the headaches until the medication overuse is stopped. The majority of people who cut down on the amount of acute medication they use, will see an improvement in their headaches. This is counterintuitive for some people and there is usually great apprehension with cutting down for fear of more pain. Patients should work with their doctors to discuss the best way to discontinue their pain medications.
Important Points:
1. Overuse of acute medication can commonly lead to increased frequency of headache
2. There are limits on the amount of acute medication that you should take in order to prevent medication overuse headache
3. A headache diary is a very good way to keep track of your medication use and avoid overuse [LINK: headache diary]
4. The majority of people who cut down on the amount of acute medication they use, will see an improvement in their headaches.
