CNN

Treating rebound headaches with early preventative meds best choice, study finds

May 26, 2020, 10:30 AM | Updated: 3:03 pm

...

(CNN) — Your head is pounding yet again. You grab another round of pain meds, only to find they no longer work.

You may be suffering from a MOH — a medication overuse headache — brought on when the very medications you relied on for relief suddenly become the enemy.

Some 60 million people around the world suffer from headaches brought on by the overuse of medication. It typically happens to people who suffer from migraines, cluster headaches or tension-type headaches who are using medications that don’t work.

When the pain doesn’t ease, they take another pill, thus setting the scene for what is often known as a “rebound” headache.

Instead of a headache that might call for pain medications two or three times a week, people with MOH now have a headache nearly every day, typically upon awakening. For many, this is a new level of chronic pain — and there’s no miracle pill to fix it.

Is cold turkey best?

Withdrawal therapy is currently the only treatment for this disorder, sometimes combined with physical or behavioral therapy and preventative medicine treatments, sometimes called “bridge therapies.”

Those preventative medicine treatments include anticonvulsants, antidepressants, beta blockers and calcium channel blockers that might help control withdrawal pain without risking medication overuse headaches. At times a patient may be given injections of Botox or antibodies designed to thwart migraines.

But not always. In Denmark, for example, guidelines suggest a complete withdrawal, totally discontinuing any pain medications for two months before other options are provided.

“Withdrawal has been recommended for years in European Guidelines, including the most recent published from May 2020,” said Dr. Rigmor Jensen, a professor of headache and neurological pain who directs the Danish Headache Center at the University of Copenhagen, and is lead author on a new study to see if those recommendations were right.

In fact, doctors have long debated whether any preventative treatments were necessary to help patients wean off medications — believing the vast majority of patients did just as well with a cold-turkey approach.

After all, most withdrawal headaches tend to improve in less than a week, although some patients did need to be hospitalized, especially if they were withdrawing from opioids.

“In placebo-controlled studies for preventive treatment, the effect has been modest,” Jensen said. “So, we decided to compare these treatment strategies directly in this study to clarify the question.”

Jensen and his coauthors hypothesized that withdrawal alone, or withdrawal with preventatives, would work better in reducing overall headache days per month than a preventative approach.

However, the results of their study, published Tuesday in the journal JAMA Neurology, surprised the authors.

While all three treatments were effective in reducing MOH, the largest reductions in headache and migraine days, days with short-term medication use and days with headache pain intensity were seen in the withdrawal plus preventive medicine group.

In addition, people who withdrew from meds with the help of preventatives had a significantly higher chance of being cured of their medication overuse headaches than patients who used preventatives or withdrawal alone.

“We were surprised of the study results and the excellent adherence to the treatment,” Jensen said. “We now recommend withdrawal and early start of preventive treatment.”

“Having good medical evidence to support the common practice of both stopping the offending agent or agents, and starting a patient on prevention medication right away, will clear up some of the controversy and confusion,” said Dr. Rachel Colman, director of the Low-Pressure Headache Program at the Icahn School of Medicine at Mount Sinai in New York.

Doctors should use this study to “provide patients with guidance, support and hopefully relief from a disabling condition,” said Coleman, who was not involved in the study.

Coleman also pointed out that due to timing of the trial, the study did not include the newest options for prevention, called CGRP monoclonal antibodies, that have become available in the last two years. These are a new class of medication created specifically for migraine headaches.

However, Jensen said that going “cold-turkey” may still have some benefits for patients, especially those with less severe rebound headaches. Prior studies have found that when patients feel their actions exert control over their headaches, it can help them from overusing medications in the future.

“Patients who withdraw completely experience that a headache can disappear by itself, and that experience is important when talking about preventing relapse into a new medication overuse,” Jensen said.

What causes a MOH?

Just how much pain medication will cause a rebound headache depends on the medicine.

According to the American Migraine Foundation, over-the-counter pain relievers, such as aspirin, acetaminophen, ibuprofen, naproxen and indomethacin, can cause MOH when used 15 or more days per month.

It will only take about 10 days of use for medications that combine caffeine, aspirin and acetaminophen to contribute to a MOH. Ten days is also the max for tryptamine- and ergotamine-based drugs often prescribed for migraines, as well as any of the opiates: oxycodone, tramadol, butorphanol, morphine, codeine or hydrocodone.

Just 200 milligrams of coffee will also trigger a medication overdose headache. That’s just one cup of coffee combined with a coke and a plain chocolate bar.

It’s not just pain in the head either. Often MOH can cause memory issues, difficulty concentrating, depression, anxiety, irritability, restlessness and nausea.

The-CNN-Wire
™ & © 2020 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

We want to hear from you.

Have a story idea or tip? Send it to the KSL NewsRadio team here.

CNN

Senate Minority Leader Mitch McConnell (R-KY) heads to the floor of the Senate for a vote on Capito...

Clare Foran, Morgan Rimmer and Ted Barrett, CNN

Mitch McConnell to step down from GOP leadership position in the Senate

Mitch McConnell will step down as GOP leader in November, the Kentucky Republican announced on the Senate floor Wednesday.

4 days ago

Soldiers carry the coffin of Ukrainian poet and serviceman Maksym Kryvtsov who was killed in action...

Stephanie Halasz and Ivana Kottasová, CNN

Zelensky warns ‘millions will be killed’ without US aid to Kyiv, as Ukrainian troop deaths reach at least 31,000

“Millions” could die in Ukraine’s war with Russia if US lawmakers don’t approve President Joe Biden’s $60 billion aid request.

7 days ago

Kathy Brandel and her husband of 27 years, Ralph Hendry...

Sharif Paget, Chris Boyette and Polo Sandoval, CNN

Family of Americans believed dead after yacht allegedly hijacked in Grenada describe scene of violence

The family of two Americans who may have been killed in an alleged yacht high jacking in Granada hope the couple might be found alive.

7 days ago

Police tape drapes the crime scene on a trail behind Lake Herrick at the University of Georgia in A...

Ashley R. Williams, Raja Razek, Priscilla Alvarez, Isabel Rosales and Jaide Timm-Garcia, CNN

Questions remain in investigation of death of Augusta University student found on UGA campus

As the investigation continues into the death of an Augusta University student, officials confirmed the immigration status of a suspect.

7 days ago

Kenneth Mitchell, here in 2018, has died....

Megan Thomas, CNN

Kenneth Mitchell, ‘Star Trek’ and ‘Marvel’ actor, dead at 49

A native of Canada, Mitchell acquired more than 50 film and television credits over the course of his acting career. He was diagnosed with ALS in 2019.

8 days ago

Charles E. Escalera, 21...

Michelle Watson and Maria Sole Campinoti, CNN

Kentucky man arrested in connection with death of Campbellsville University student

A man has been arrested in connection with the death of a student at Campbellsville University in Kentucky.

8 days ago

Sponsored Articles

Mother and cute toddler child in a little fancy wooden cottage, reading a book, drinking tea and en...

Visit Bear Lake

How to find the best winter lodging in Bear Lake, Utah

Winter lodging in Bear Lake can be more limited than in the summer, but with some careful planning you can easily book your next winter trip.

Happy family in winter clothing at the ski resort, winter time, watching at mountains in front of t...

Visit Bear Lake

Ski more for less: Affordable ski resorts near Bear Lake, Utah

Plan your perfect ski getaway in Bear Lake this winter, with pristine slopes, affordable tickets, and breathtaking scenery.

front of the Butch Cassidy museum with a man in a cowboy hat standing in the doorway...

Bear Lake Convention and Visitors Bureau

Looking Back: The History of Bear Lake

The history of Bear Lake is full of fascinating stories. At over 250,000 years old, the lake has seen generations of people visit its shores.

silhouette of a family looking over a lake with a bird in the top corner flying...

Bear Lake Convention and Visitors Bureau

8 Fun Activities To Do in Bear Lake Without Getting in the Water

Bear Lake offers plenty of activities for the whole family to enjoy without having to get in the water. Catch 8 of our favorite activities.

Wellsville Mountains in the spring with a pond in the foreground...

Wasatch Property Management

Advantages of Renting Over Owning a Home

Renting allows you to enjoy luxury amenities and low maintenance without the long-term commitment and responsibilities of owning a home.

Clouds over a red rock vista in Hurricane, Utah...

Wasatch Property Management

Why Southern Utah is a Retirement Paradise

Retirement in southern Utah offers plenty of cultural and recreational opportunities. Find out all that this region has to offer.

Treating rebound headaches with early preventative meds best choice, study finds