headache

Daily Headaches: when the cure hurts

by Barry Bittman, MD

An occasional headache is a fact of life for most people in our society. For the majority of us, relief is simply the first over-the-counter remedy we find in our medicine chest or desk.

For others, headache is a daily occurrence that often becomes an overwhelming nightmare that renders every enjoyable moment into a lifetime of pounding, squeezing and crushing agony.

Headaches are big business. Just check out the pain aisle in your local drug store, or think about those annoying commercials that seem to always tell you what your doctor recommends. Those advertisements sell incredible quantities of drugs that are not as harmless as they seem.

To prove my point, consider the fact that one of the most common causes of chronic daily headaches is the overuse of the remedy itself. In medical circles, two conditions are noteworthy. The first is called "transformed migraine" and the second is referred to as "rebound headache."

Transformed migraine sufferers are typically individuals who experience occasional headaches in their early years. Over time, headaches increase in frequency, and sufferers, in an attempt to relieve pain, progressively use more and more symptomatic medication. Eventually, a few Tylenols, Excedrins or prescription pain-killers are taken prior to work every day in anticipation of a headache that may develop. It is not uncommon to take a few more just after lunch, before returning home, or prior to a meeting. Often, one cannot leave home without an adequate supply.

Just a few pills three or four times a day quickly adds up to more than 200 pills/month. Eventually, a phenomenon termed, "rebound" occurs, which refers to the intensification of headache upon attempting to stop the use of the medication.

Rebound headache sufferers simply overuse the very same drugs in order to alleviate headaches. Most, however, are not addicted to narcotic agents. It is a little known fact that even a few Acetaminophen tablets taken on a daily basis for an extended period of time can produce rebound headaches.

When one considers the fact that the condition most commonly self-treated with over-the-counter medication is headache, the enormity of this problem becomes apparent. It has also been reported that approximately 40% of patients seen at major headache clinics suffer from chronic daily headaches.

In addition to the self-sustaining nature of the pain itself, rebound headaches are associated with a host of problems. Foremost is the fact that prescribed preventative headache medicines are ineffective until the rebounding agent is discontinued. It is frankly impossible to estimate how many headache prevention strategies fail because of concomitant over-the-counter medication use.

Additionally, when used excessively, these over-the-counter medicines are associated with significant side effects and health risks including bleeding and liver/kidney failure. While some patients consume phenomenal amounts (one of my patients admitted to 1200 pills/month), most individuals follow the package labels. The real problem is that there are hundreds of headache remedies that line the drug store isles. Unfortunately, however, there are few variations of a very basic theme. The same ingredients essentially appear in most packages, thereby resulting in overdosing when one consumes a combination of products.

In essence, understanding rebound headaches is a far cry from effectively treating it. The following recommendations are likely to provide a useful starting point:

Begin by formally tracking your prescription and over-the-counter pain-killer pattern of use with accurate records. Maintain a headache diary that includes a notation of every headache, its intensity and the drug you used to treat it. Include your response to treatment, and ask yourself at the end of each day, whether or not the drugs actually helped.

Attempt to slowly diminish the number of pills taken on a daily basis. Stopping "cold turkey" is not advised, as it is likely to result in marked headache worsening.

Discuss your headaches with your personal physician, and show him/her your journal. If attempts to discontinue medications and treat your headaches are unsuccessful, ask for a referral to a headache specialist. A coordinated program using preventative medication, dietary management, relaxation strategies, biofeedback and exercise techniques are likely to produce substantial benefits.

Be prepared for the fact that it may take 30 to 60 days off these medicines before your body can reset its own headache control mechanisms. The promising news is that most chronic daily headache sufferers can be successfully treated and withdrawn from the agents that triggered the problem in the fist place.

Essentially, the first step is yours. Why not begin by not reaching for the pill ¾ Mind Over Matter!