Rebound Headaches: How to Get Rid of Medication-Overuse Headaches

The story of a typical rebound headache may sound familiar to you. You have been dealing with chronic migraines for years. Your provider recommends a medication and your symptoms finally start to improve. You feel much better, your headaches are gone, and you can get back to your life. But, after a while, you start having headaches again. You keep taking your medication, but this time, they feel different than your chronic migraines. What’s going on? 

This is a rebound headache, also known as a “medication-overuse headache.” Data suggest that about 1% of the general population in Europe, North America, and Asia have medication-overuse headaches. If you’re curious if this includes you, read on to learn more about rebound headaches. 

What is a rebound headache?

A rebound headache, or medication-overuse headache, is when someone with chronic headaches develops a new headache related to using a medication. This occurs because frequent use of a pain reliever can worsen a preexisting headache or lead to a totally new form of daily headaches.

You may be diagnosed with a rebound headache if you meet these three criteria:

1. You’ve had the headache for 15 or more days in 1 month, and you already have a preexisting headache disorder, like migraines.

2. For more than 3 months you’ve been overusing at least 1 pain reliever that treats headaches.

3. There’s no other diagnosis likely to explain this headache.

You may be wondering what qualifies as “overuse” of a medication. There’s actually no simple answer to this question, and it depends on which medication you’re taking. The International Classification of Headache Disorders defines overuse as taking a medication:

1. More than the prescribed dosing

2. For more than 10 days in a month

3. For more than 3 months 

Overuse can also be considered when someone uses more than one medication for headache relief. This can seem arbitrary. If you’re concerned, talk to your provider about your medications and dosing. 

Which medications can cause rebound headaches?

There are a variety of medications that can be used to treat headaches. Overuse of any of these can lead to a rebound headache. Here is a list of the more common prescription and over-the-counter (OTC) medications that can lead to rebound headaches: 

• Opioids, such as oxycodone and tramadol

• Ergotamine tartrate

• Butalbital, which is found in the popular medication Fioricet

• Caffeine, either from OTC pills like Excedrin or caffeinated beverages

• Aspirin

• Acetaminophen (Tylenol)

• Triptans, like sumatriptan, rizatriptan, and zolmitriptan

• NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve)

• Nasal decongestants, like pseudoephedrine (Sudafed)

What does a rebound headache feel like?

If you’re already having migraine headaches, it can be hard to know what a rebound headache feels like. But there are some characteristics that can help. Rebound headaches often:

• Happen daily or every other day

• Feel dull, but last long 

• Feel worse in the morning than at night

• Come back after the pain reliever wears off

Other symptoms that can occur with a rebound headache include: 

• Nausea

• Anxiety and restlessness

• Difficulty concentrating or remembering things

• General weakness or lack of energy

Medication-overuse headaches, or rebound headaches, are usually more of a nuisance than a danger. But if you’re experiencing a new headache and you aren’t sure of the cause, don’t hesitate to get medical help. This is especially true if you have the following symptoms:

• A severe headache that started suddenly

• Fever or stiff neck

• Confusion or drowsiness

• Loss of consciousness

• Loss of strength or sensation in one part or one half of the body

• Vision loss

How long do rebound headaches last?

Rebound headaches often occur daily or every other day. They may last anywhere from 6 hours to all day. They usually feel worse in the morning. 

Rebound headaches are part of a painful cycle: You have a migraine, and you take medication to treat that migraine. But if you take too much, you get a rebound headache. Then, you take a pain reliever to get rid of the headache, and the cycle continues. Rebound headaches can last until the cycle is broken, which can take weeks to months.

How to get rid of rebound headaches

The key to treating a rebound headache is to discontinue the medication that is causing the problem in the first place. The symptoms and length of time of this “withdrawal” period depend on the medication that was being overused. 

Withdrawal symptoms can be treated with IV (intravenous) fluids and other medications. This includes:

• Beta blockers

• Clonidine

• Valproic acid

• NSAIDs, like naproxen

• Tizanidine (Zanaflex), often along with naproxen

• Dihydroergotamine 

• Antinausea medications, like Zofran (ondansetron)

• Steroids, like prednisone

Talk to your provider about your options for treatment. They can help recommend the best treatment plan for you. 

How to prevent rebound and medication-overuse headaches

There are three key ways to prevent rebound headaches before they begin. These are also effective steps to treat rebound headaches or any withdrawal symptoms from that process.

1. Take pain medications according to instructions

Whether you’re taking OTC or prescription migraine medications, follow your healthcare provider’s directions closely. You’ll find directions for OTC medications directly on the box or bottle label, but your healthcare provider may recommend a lower dosage for you depending on your health. 

Your provider will also provide specific instructions for any prescription medications. These directions will help you get the full benefit of the medication without increasing your risk of side effects, like medication-overuse headache.

2. Don’t take pain medications longer than advised

Ask your healthcare provider how long you can safely take your pain medication. Instructions on OTC and prescription medications should also include guidance on how long to take the medication and when to stop. 

But just like the dose recommendations, it’s a good idea to always check in with your provider. If you’re worried about stopping a medication based on your provider’s recommendations, talk to them about your concerns. Together you can come up with a plan to make sure your treatment plan is both effective and safe. 

3. Avoid extra caffeine from beverages and foods

Many people with migraines take Excedrin Migraine, a popular OTC medication that contains caffeine. If you take this medication, do your best to avoid additional caffeine from coffees, teas, and sodas. This can trigger rebound headaches — and regular headaches. 

Research shows that people who consume more than 400 mg of caffeine a day are more likely to have migraine headaches. This will also save you from caffeine withdrawal headaches when you have to cut back.

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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