Analgesic headaches

The frequency of my migraines has increased to just about daily, but they are generally only of a moderate intensity.

I have begun to wonder if they may be analgesic headaches. According to some sites I have been reading, you only need to take painkillers around three times a week over a period of time in order to develop analgesic headaches.

I have been taking paracetamol and diclofenac just about daily, and occasional sumatriptans (a couple per week).

My questions:

Does this sound like analgesic headaches?

Which med out of paracetamol, diclofenac and sumatriptan is most likely to cause analgesic headaches? All of them?

How do you get out of the cycle? I work fulltime and can't see how I can simply stop taking painkillers.

Thanks for any help or advice anyone can give.

Hey Josph,

Welcome. This is a question we have been throwing around the forum for years. We have yet to determine an answer. We haven't figured out who gets them, if they are different from migraine, nothing.

It's called many things MOH (medication overuse headache) and Rebound headache. You can search the achives under those phrases.

Sorry I can't be more helpful.

Hi Josh,

Welcome and sorry to hear things aren't so good at the moment.

I'm no medic but, from what I can tell, if the extra headaches are migraines I doubt they are to do with medication overuse. It seems to me that the MOH are more like a tension headache.

However, this was not what I was told years ago when my migraines worsened in frequency. I was most definitely told then that I should go without pain meds for 2 weeks to break the cycle, which is what I did but things stayed the same. This is the only real way to find out if the change is due to medication overuse. The good thing is that, if it is MOH, it's easily sorted.

The first thing I would do is to go to see your doctor as it's important to discuss any significant change in the pattern of your headaches just in case.

All the best

G'day Josh,
nice to see you here, but so sorry about your head.

This indeed is a very sensitive issue.
Many people do not belive that MOH exists (patients), but others (doctors) are ready to insist that most of our h/aches and migraines are cause by medication overuse.
I think that the best form of action is:

read as much as you can on the subject and you can start with this useful site:
http://www.patient.co.uk/health/Headache-Medication-Induced.htm
and see what you think, and if this might apply to you.

the next step is hard: you will never know if you have it or not, unless you try.

You need to stop using all youre painkiller or triptan completely and see if at the end of that period your daily/frequent pain is still there.

My advice is to do it under medical supervision, best in hospital so they can help you to stop any pain by injections from DHE45.

Anyway you have it all explained in the article.

Once the pain is gone you can start on the course of preventative such a topomax or neurontin, or whatever you neurologost suggests.

It can work very well, it has worked for me well and yes, I do believe MOH exists, I also think that there are exeptions when the treatment does not work, or people are not able to handle beeing off painkillers even for few days.

It is hard. But it is not nearly as hard as I thought. I am glad I took that chance - it gave me much of my life back, as I do not get nearly as many migraines as i did in the past. Give yourself a chance, it might work and be really great for you. Nobody will know if it works unless they try.

You need a good neurologist to help you considering all your options, though.
Good luck and welcome to our forum
Senna
PS Let me know if this was useful

HI Joshp,

We have a topic on here under MOH if you take a look you might get some more clues.
My neruo tells me Paracetamol is the least likely to cause MOH, BUT he also says it doesn't help with migraine....
I cant say that is a fact but it is his opinion.
NSAIDS (diclofenac) are also not the worst culprits but Ibuprofen come within that group and then can do it.
Triptans until fairly recently were said not to cause MOH, but now they have decided they can.

As my fellow posters here say, it is an enigma. We are bated with it by doctors and some people get off all the medication to see if they have it. I have no idea of statistics, but for some it helps. For others it makes no difference. Some of us end up with more headaches worrying about making ourselves worse trying to resolve our pain.

I think my best advice would be to see the doctor who is giving you the Diclofen for his opinion.
Presumably he diagnosed your migraine...
Then depending on the response, if you can take a couple days off....a long weekend maybe 4 days or so, and try to not take anything. It isnt long enough to solve anything but it might give you a clearer picture.

As I understand it, if you do have it, then the only way to resolve it is to cut out of change the medication.
Dr can help you with this.

Good luck.

Josh,

Forgot to say that I understand that all the drugs you mention can cause MOH to some extent. As Pen says, I've been told that paracetamol is pretty useless for migraine.

Senna's right and MOH has been a sensitive issue here. I'm sure there is some truth in it and I for one am always very careful about what I take. As she says you won't know if you're affected until you come off all the stuff. Definitely discuss the situation with your doctors first though. I don't know if you could get in-patient medical supervision. I know I definitely couldn't here and would be expected to manage without altenative pain management but it would only be for a short while.

John, just to clarify - I am in UK, and I did get that excellent hospital treatemnt in UK.
I am not sure if the same applies to Wales, but under NHS we do have a right to see any specialist we choose, in any hospital we choose, so you can have that option if you ever choose to do that.
Do let me know if I can be of help
Senna

Hi,
this is a quite controversial topic. Any patient/doctor has their own opinion.
I think that it's very difficult to determine whether continous migraine causes daily use of pain killers or if the daily use of drugs causes migraine....

I agree with both thories in a certain way. In fact, I think that there are abusers who just need to take drugs for problems not directly linked to migraine or headache.

Hypocondriac patients or people who have daily generic pain (maybe to autoimmune diseases that they are not aware of) may abuse medicines. And - with certain meds - the h/a can be a side effect of the overuse. I doubt that paracetamol is one of these.
I think that these patients are a minority and are not real migraine sufferers.

Instead, I am quite sure that each migraine sufferer has experienced at least once in life the daily pain that obliges to use anti-inflammatories.

As a personal rule, when I have these bad periods, I simply give up everything and suffer 24/48 hours in bad pain and nausea. When the pain has gone, the cycle ends and migraine is no longer daily. Just my opinion anyway. Neuros say that a migraine attack should never be underevaluated but aborted...

John,
to add to what I said before, this is a useful website about NHS patients rights:
http://www.adviceguide.org.uk/index/family_parent/health/nhs_patients_rights.htm#Righttohospitaltreatment

but of course as I said before I am not sure how much of it applies in Wales.
Senna

Senna wrote:John,
to add to what I said before, this is a useful website about NHS patients rights:
http://www.adviceguide.org.uk/index/family_parent/health/nhs_patients_rights.htm#Righttohospitaltreatment

but of course as I said before I am not sure how much of it applies in Wales.
Senna

Unfortunately the "NHS choices" policies only apply to England and not Wales. I've had big problems seeing migraine specialists in England as I don't have the right to choose a specialist. In theory my local health board chooses who I get to see. In practice I get refered to a local neuro who is totally out of his depth and is happy to then recommend a referral on to someone else outside Wales. The down side is that this all takes time.

What I was trying to say was that I've not personally met a migraine sufferer who has received in-patient treatment and it wasn't raised as a possibility for me even when I was really desperate and suicidal due to the level of persistant pain. I know that others who post here have spent time in hospital but thought this only happens in the states. So I am pleased to hear that you got hospital treatment here in the UK.

Dear Josh,
I have had 24/7 pain for 38 years. My pain is at a very high level, and gets even higher with weather/barometric pressure changes; various foods--the list grows longer every year; certain smells--every dental visit is torture: the neck back, mouth open, head turned toward dentist and the SMELLS; flashing lights...I am sure most of you have equally long lists.

I have tested over 130 meds, most for 3-12 months. It has destroyed my stomach and made me even more sensitive to medications, which I was from the beginning.

What you are talking about is rebound pain. You take a medication and when it wears off, your pain returns even stronger than it was before taking the med, or at about the same level. It can become a vicious cycle. Some patients and doctors do not believe in rebound at all, but I certainly do, as do most of my neurologists, as I have experienced it dozens of times over the years.

Nothing has ever stopped my pain, not for one instant. And only a few meds have been able to keep it at a very high level, but I would be in bed more days than I already am without my meds. Too many drs fooled around with too many absurd meds when the only thing that would ever help are pain meds. Several drs have since admitted this to me, but said it was their office policy not to give out narcotics---too much monitoring needed.

All meds that reduce my pain cause it to return in rebound form, or at the least, at the same level as before the shot or pill. I never go to the ER no matter how sick I am as I know that even if I could persuade someone to give me a strong pain med, once it wore off, I would be worse off.

I am telling you this to explain that I am the queen of rebound. In fact, two different clinics (one was the diamond clinic) called me Ms. Rebound. My father was the same way. He never took any meds until his 70's, but he often had the opposite reaction that the med was supposed to produce---as I often did. Or his condition was made much worse---same with me.

"Paracetamol is known as acetaminophen in the United States"

"Diclofenac is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause inflammation and pain in the body. Brand names are Cambia, Cataflam, Voltaren, Zipsor"

----- from drugs.com.

I have certainly had rebound from tylenol if I took it daily for several days or weeks. I do not know what Diclofenac is comparable to in the US, but I certainly have had rebound from advil, naproxyn sodium (anaprox), motrin, and many many other NSAID's. Sometimes it took one dose, usually a few days or weeks.

I have also had rebound from one dose of certain triptans----though that is unusual. And one dose of certain muscle relaxers or one dose of codeine will cause rebound in me. As will drinking strong coffee.

I stress that I am highly sensitive, most likely because my system has tested far too many meds for too long a time. Certain meds like percodan and codeine caused rebounds from day one, so I was sensitive to start with, but again I want to emphasize how unusually sensitive I am.

The only way to test if you are having rebounds, as others have said, is to stop the medsmeds slowly.There are many taper schedules available online. Many drs know nothing about tapering and will tell you just to stop a med. One told me to stop taking huge amounts a a narcotic I was taking for 3 months after an auto accident and insisted I would not experience any side effects. Get a pill splitter and go slowly.

I wish you luck. Many drs swear "Medication Overuse Headaches" are responsible for a great majority of headaches. Whether you classify your pain as migraine, headache, tension headache, etc. it is all still pain. A great many drs feel the h/a classification does not do much good as they eventually use the same drugs for every "type" of h/a that exists.

I think you know what you have to do. I have stopped taking all meds many many times. It was excruciatingly difficult to do, and it proved nothing except that I am in slightly less pain with meds than without. I have it tests as long as 2 years with nothing at all, and I felt I had to do it, but I suffered badly for it.

I am not quite sure I understand your problem, did you pain become daily after taking the meds daily? I take meds daily, bu they are long acting medications designed to prevent rebound. Usually if you feel the meds may be causing a problem, you could be right. On the other hand, you may need the meds daily and in looking for some answers, felt this was worth a trial. We have all heard stories about people whose pain went away after they stopped all their meds.

Please ask any questions you may have---I have a horrid one right now and this seems kind of out of order, but I hope the meaning is there.

This is so difficult to do when you do not work, so because you do, you must taper extremely slowly if you feel the need to test this theory. Remember, I do not know anything for sure---you may need these meds as often as you take them.

Good luck and keep us informed,

Mishkyn

Howdy

Mishkyn, it is real good to see you posting - I know that even posting can be a challenge given your levels of pain. But I am grateful you shared your wisdom with Josh and with the rest of us ... I usually learn when you post. thanks. I hope this finds you getting a break in the cycle - even a small break.

"Paracetamol is known as acetaminophen in the United States"

My PCP who specializes in headaches specifically told me not to take acetaminophen b/c it has caffeine and is more likely to cause rebound. Once I hear that I stopped taking it.

hi jeselle just for info, in the UK most pain relief that can be bought otc, has a with caffeine option and a without, even cold remedies and hayfever meds,

i by a bit of both sometimes i find paracetomal with caffeine, along with diclofenic if taken early enough can help ward off a biggy, but thats only the case now that i am on 2 preventatives (reducers as well), b4 that the above would not even of scratched the surface,

John, sorry for dely in response (I was quite ill y-day with a very bad cold: chest, cough, neck, head the full works - I am still not well so bear this in mind in case something is not clear - I will be happy to explain.

But first I just want to say that I am terribly, terrinly sorry that you have in the past and that your are suffering so much.
Please do not give up hope. Sometimes you have to fight time and time again, to get what you need, and this is definitely the case. You are entitled to the best treatment. You can demand it (in a nicest possible way of course).

I am sorry the NHS choice does noto apply in Wales (what a terrible shame) but the sooner your start to ask for such referal, the sooner you will start moving on any waiting list.

IN my casee I waited almost two years, but I wanted a particular specialist and it was many years ago.
But in the end it was really worth it - the treatment for stopping OC medicines overuse has really worked for me, and for many other people here. It does not work for everyone, you also must be very motivated and watch it in the future, but it might for you so it is worth a try.

You can do it also by yourself; slowly, gradually as Mishkyn described but I when I wasoffered the options of DHE45 in hospital tretment (5days) and am glad I did it - even if before that I was extremely doubtful that it was going to work.

If you want any more information, please let me know, or post a message if this is easier for you.
Must go I am falling asleep. It is late
Hope you are having a better day
Senna

You can get tylenol with codeine without caffeine...it's called emtec here in Canada.

Thanks for all of the replies and advice. I've done further reading and it seems that MOH is quite poorly understood, so there are no exact answers.

I think I may be an MOH candidate, though, because I know that I very easily get rebound headaches from caffeine. I only need to have a single cup of coffee for two or three days in a row, and if I don't have a coffee the following day, then I will almost certainly get a headache. Perhaps this means I am susceptible to painkiller rebound as well.

My problem is that I don't know how to reduce the amount of painkillers I take. I have tried several migraine preventatives (including beta blockers, topiramate, epilim) and none of them has had any impact. I'm also taking feverfew, CoQ10 and B2 with no effect.

My idea is to alternate the meds I take, so that I don't take any one drug more than twice a week. Problem with this is when I take, say, paracetamol or aspirin, it often does nothing. This means that on those days I will just have to suffer and get worse.

This is all very depressing.

I've had moderate to severe migraines for over seven years. Anytime I see a new doctor the first thing they say is "most of my headaches are probably rebound headaches". However I dropped all pain meds for two months and the headaches never stopped, nor did the daily pattern change.

So at least in my case, I know I'm not having rebounds.

Jeselle,
Acetaminophen (tylenol) does not have caffeine in it unless it is added. It often is combined with caffeine, but not always. Aspirin can be combined with caffeine as well. That is why it is so important to read labels.

"DRUG CLASS AND MECHANISM: Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated. The FDA approved acetaminophen in 1951." Medicinenet.com
Mishkyn