When headache medications cause your headaches

Billions of people worldwide suffer from either migraine or tension-type headaches, and when these painful episodes occur, those stricken often reach for over-the-counter painkillers like ibuprofen, acetaminophen, and aspirin, or prescribed medications like triptans (migraine drugs) or even opiates. The relief these treatments provide is priceless to anyone regularly afflicted with head-splitting pain.

But in some cases, when used in excess, they can lead to a peculiar disorder called “medication overuse headache.” An international team of researchers detailed this often-debilitating condition in an article recently published in Nature Reviews Disease Primers.

Medication overuse headache

Patients already diagnosed with a headache disorder who endure 15 or more headaches per month and regularly overuse any of the aforementioned drugs — that is, using them more than two or three days per week, often at excessive doses — may suffer from medication overuse headache. The disorder affects an estimated 100 million adults globally. Ibuprofen (Advil) and naproxen (Aleve) are least likely to trigger the condition, while acetaminophen (Tylenol), migraine medications, opioids, and combination pain relievers like Excedrin are most likely to contribute.

“Many cases are the result of misguided self-treatment, but some cases, especially those involving triptans, barbiturates, or opioids are due to incorrect prescribing, with many clinicians unaware of the risks of medication overuse headache and of the strategies to prevent and manage it,” the authors wrote.

It’s easy to understand how migraine sufferers can get seduced into overusing pain-relieving medications. Anyone who has experienced one knows how terrible they can be. The Mayo Clinic describes the experience as “severe throbbing pain or a pulsing sensation, usually on one side of the head… often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.” Anxiety over these painful episodes can drive those prone to them to go beyond the recommended dosages of their drugs, or even to take them prophylactically, despite the fact that they aren’t preventative. Increased drug use triggers more headaches, which prompts more drug use. It’s a vicious cycle.

According to the researchers, what’s going on in the brain to cause medication overuse headaches remains “incompletely understood.” Neuroimaging studies have revealed differences in the structure of various brain regions in medication overuse headache patients, but that tells us little. More elucidating, scientists have noticed changes to the brain’s dopamine system in people with the disorder. Dopamine is a neurotransmitter with various roles including reward, pleasure, and motor control.

Research also has shown that headache medications seem to alter peripheral nociceptors, sensory receptors for painful stimuli, which could increase one’s vulnerability to sensing pain.

The treatment is no treatment

The best treatment for medication overuse headache is blunt but effective: discontinuing the use of headache medications — though sufferers could turn to unconventional treatments like psilocybin to ease the process. While patients may experience excruciating headaches off and on for days or even weeks as a result, the “cold turkey” treatment resolves almost all cases within two months, greatly decreasing patients’ headache frequency. Moreover, about four in five patients remain cured one year later.

Ultimately, the best way to avoid medication overuse headaches is to reduce your chances of getting headaches in the first place. Getting enough sleep, avoiding caffeine, staying hydrated, exercising, maintaining a healthy weight, eating regular meals, and abstaining from smoking all keep headaches at bay.