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Treatments and drugs
By Mayo Clinic staffTo break the cycle of rebound headaches, you'll need to restrict how much pain medication you use. Depending on what drug you've been taking, your doctor may recommend stopping the medication right away or gradually reducing the dose until you're taking the drug no more than twice a week.
Withdrawal symptoms
Stopping pain medication isn't easy. Expect your headaches to get worse before they get better. You also may experience withdrawal symptoms such as nervousness, restlessness, nausea, vomiting, insomnia, abdominal pain, and diarrhea or constipation. But it doesn't last forever. Within a week to 10 days, your headaches may become less intense and less frequent. With perseverance, most people break the rebound headache cycle within two months.
Your doctor may prescribe various treatments to help alleviate headache pain and the side effects associated with drug withdrawal. Dihydroergotamine (D.H.E.), an injectable ergot, helps relieve rebound headache pain during the withdrawal process. When taken during the withdrawal period, D.H.E. also seems to reduce the incidence of future relapses.
Hospitalization
Sometimes it's best to be in a controlled environment when you stop taking pain medication. A short hospital stay may be recommended if you:
- Haven't been able to stop using pain medication on your own
- Have other conditions, such as diabetes, depression or anxiety
- Are taking high doses of drugs that contain opiates or the sedative butalbital
- Are abusing substances such as tranquilizers or decongestants
- Are experiencing prolonged, unrelenting headaches with other signs and symptoms, such as nausea and vomiting
Preventive medications
After you've broken the rebound headache cycle, you and your doctor can find a safer way to manage your headaches.Before, during or after withdrawal, your doctor may prescribe a daily preventive medication, such as:
- A tricyclic antidepressant such as amitriptyline or nortriptyline (Aventyl, Pamelor, others)
- An anticonvulsant such as divalproex sodium (Depakote, others), topiramate (Topamax) or gabapentin (Neurontin)
- A beta blocker such as propranolol (Inderal, InnoPran, others)
These medications can help control your pain without risking another cycle of rebound headaches. If you're careful, you may be able to take a medication specifically meant for pain during future headache attacks. Be sure to take any medication exactly as prescribed.
