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.

Today’s Top Stories

CNN

First responders work the scene of a shooting at a Fourth of July parade on July 4, 2022, in Highla...
Amir Vera, Jason Hanna, Adrienne Broaddus and Helen Regan, CNN

Highland Park parade shooting suspect charged with 7 counts of murder, state’s attorney says

Officials in Illinois have filed seven counts of first-degree murder against the individual suspected of being involved in the Highland Park shooting Monday.
1 day ago
Police in Highland Park, Illinois, respond to a shooting at a Fourth of July event....
Eric Levenson, Adrienne Broaddus, Shawn Nottingham and Brynn Gingras, CNN. Mark Jackson

Police have arrested a ‘person of interest’ after a mass shooting at July 4th parade in Highland Park, Illinois

Robert E. Crimo III, a person of interest in a mass shooting at a parade that left six dead and sent more than two dozen people to hospitals, has been taken into custody near Lake Forest, Illinois, authorities said during a brief news conference.
2 days ago
People leave Field's shopping centre, after Danish police said they received reports of shooting, i...
Kim Norgaard, Pierre Meilhan and Jorge Engels, CNN

Several people killed in Copenhagen mall shooting, police say

shooting at a mall in Copenhagen has left several people dead, local police said Sunday.
3 days ago
Joseph Petito, father of Gabby Petito, speaks during a news conference on Tuesday, September 28, 20...
Jennifer Henderson, CNN

Florida judge allows lawsuit filed by Gabby Petito’s parents against Brian Laundrie’s parents to proceed

A lawsuit filed by Gabby Petito's parents will move forward, a Florida judge ruled Thursday. The lawsuit is against the parents of Brian Laundrie.
6 days ago
Immigration activists rally outside the US Supreme Court in Washington, DC on April 26. Photo credi...
Tierney Sneed and Priscilla Alvarez, CNN

Supreme Court says Biden can end Trump-era ‘Remain in Mexico’ immigration policy

The Supreme Court on Thursday gave President Joe Biden the green light to end the controversial "Remain in Mexico" immigration policy.
6 days ago
Justice Stephen Breyer and President Joe Biden....
Ariane de Vogue, CNN Supreme Court Reporter

Breyer makes it official: He’s leaving the Supreme Court on Thursday at noon

In a letter to President Joe Biden, Breyer said it had been his "great honor" to participate as a judge in the "effort to maintain our Constitution and the Rule of Law."
7 days ago

Sponsored Articles

Tax Harassment...
Jordan Wilcox

The best strategies for dealing with IRS tax harassment | You have options!

Learn how to deal with IRS tax harassment. This guide will teach you how to stop IRS phone calls and letters, and how to handle an IRS audit.
spend a day at Bear Lake...
Bear Lake Convention and Visitors Bureau

You’ll love spending the day at Bear Lake | How to spend a day at Bear Lake

Bear Lake is a place that needs to be experienced. Spend a day at Bear Lake.
Curb Appeal...
Price's Guaranteed Doors

How to have the best of both worlds for your house | Home security and curb appeal

Protect your home and improve its curb appeal with the latest security solutions like beautiful garage doors and increased security systems.
Prescription opioids can be disposed of during National Prescription Take Back Day...
Know Your Script

Prescription opioid misuse | How to protect your family from the opioid epidemic

Studies have shown that prescription opioid misuse has increased since COVID-19. So what do you need to know about these opioids?
national heart month...
Intermountain Healthcare

National Heart Month: 5 Lifestyle Changes to Make Today to Keep You Heart Healthy

Heart disease is the leading cause of death for both men and women. One person dies every 36 seconds in the United States from cardiovascular disease
Joseph Smith Memorial Building...
Temple Square

The Joseph Smith Memorial Building is an icon of Salt Lake City | Why hosting an event at this beautiful location will make you a hero this year

Here's why hosting an event at the iconic Joseph Smith Memorial Building in downtown Salt Lake City will make you a hero this year.
Treating rebound headaches with early preventative meds best choice, study finds