Analgesic Rebound Headache

THE CLINICAL SYNDROME

Analgesic rebound headache is a recently identified headache syndrome that occurs commonly in headache sufferers who overuse abortive medications to treat their headache symptomatology. The overuse of these abortive medications will result in increasingly frequent headaches that become unresponsive to both abortive and prophylactic medications. Over a period of weeks, the patient’s episodic migraine or tension-type headache becomes more frequent and transforms into a chronic daily headache. This daily headache becomes increasingly unresponsive to analgesics and other headache medications, and patients will note an exacerbation of headache symptomatology if abortive or prophylactic analgesic medications are missed or delayed. Analgesic rebound headache is probably underdiagnosed by healthcare professionals, and its frequency is on the rise due to the heavy advertising by pharmaceutical companies of over-the-counter headache medications containing caffeine.

The classic temporal relationship of abortive medication intake to onset and relief of analgesic rebound headache.

SIGNS AND SYMPTOMS

Clinically, analgesic rebound headache presents as a transformed migraine or tension-type headache and may assume the characteristics of both of these common headache types, blurring their distinctive features and making correct diagnosis difficult. Common to all analgesics rebound headaches is the excessive use of the following medications (summarized in Table below): simple analgesics, such as acetaminophen; sinus medications, including, simple analgesics; combinations of aspirin, caffeine, and butalbital, such as Fiorinal; nonsteroidal anti-inflammatory drugs; opioid analgesics; ergotamines; and the triptans, such as sumatriptan. As with migraine and tension-type headache, the physical examination will most often be within normal limits.

Drugs Implicated in Analgesic Rebound Headache

Simple analgesics
Nonsteroidal anti-inflammatory drugs
Opioid analgesics
Sinus medications
Ergotamines
Combination headache medications that include butalbital
The triptans (e.g., sumatriptan)

TREATMENT

Treatment of analgesic rebound headache is the discontinuation of the overused or abused drugs and complete abstention from them for a period of at least 3 months. Many patients cannot tolerate outpatient discontinuation of these medications and will ultimately require hospitalization in a specialized inpatient headache unit. If outpatient discontinuation of the offending medications is considered, the following should be carefully explained to the patient:

1. Their headaches and associated symptoms will get worse before they get better.
2. Any use, no matter how small, of the offending medication will result in continued analgesic rebound headaches.
3. The patient may not self-medicate with over-the-counter drugs.
4. The significant overuse of opioids or combination medications containing butalbital or ergotamine will result in physical dependence, and their discontinuation must be done only under the supervision of a physician familiar with the treatment of physical dependencies.
5. If the patient follows the physician’s orders regarding discontinuation of the offending medications, he or she can expect the headaches to improve.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.