Rebound and Daily Chronic Headache (DCH)
The dictionary definition of the word rebound is to start back or to repeat.
When we refer to rebound headache in our articles it is usually in connection with the overuse of analgesics and the effect these have in creating a cycle of daily headache. This is a very common condition often causing a migraine sufferer to believe that they are experiencing constant on-going migraine but is in fact a situation where medicating for it causes a repeat of symptoms. Rebound headaches can be as severe and disabling as other types of acute migraine.
Studies of case histories have revealed that many people have had a reduction in the intensity and frequency of their migraines after opting to reduce their medication. The important thing is to be aware of this cause and effect scenario. Many preparations that give relief for migraine will cause it to reoccurr if withdrawn. The ergotomine based drugs are those best known to cause rebound headache if there is overuse.
Caffeine
Caffeine, a standard ingredient in some medications will cause headaches as many people can attest to who have been heavy coffee drinkers and missed their usual brew or tried to change to a decaffeinated type. When coffee is withdrawn from the system it can take some time for the body to adjust and a headache may persist until more coffee is consumed. Cola drinks and tea to a lesser extent can also have this effect. In a similar way medications for migraine can foster a dependency of a sort. Some people over medicate, believing that because their headache is severe they can justify taking more than the recommended dosage.
Often they have delayed taking the medication at the onset of the headache and because of “stomach shutdown” the painkiller has not been readily absorbed into the bloodstream. Then, when the symptoms persist, believing that they are experiencing a worse headache than usual or it is present the next day, proceed to take more medication. This cycle needs to be broken. It is a case of being unaware that unwittingly you are doing something harmful to your body. Rebound and /or daily chronic headache can arise from over medication but also as a direct result of the make up of the drug itself.
Although there are no definite strict guidelines, rebound headache can occur when patients take:
- 3 or more simple analgesics per day on 5 or more days of the week
- 1 or more triptan or combination analgesic (containing butalbital, caffeine, or sedative) on 3 or more days per week
- 1 or more opiate or ergotamine tartrate dose on 2 or more days per week.
Experts believe that migraine is caused by a chemical signal that activates sensors in the brain, leading to inflamed and expanded blood vessels. Sufferers seem to be vulnerable to both internal and external triggers.
Many migraineurs will have made a conscious effort to track down what they feel may be contributing factors of their headache but may have assumed something other than the real problem. Situations where an unknown irritant is present may create repeated headache in susceptible people. It can often go undetected because it is not automatically considered a migraine trigger.
Things affecting the body system can often be traced to products such as chemicals used in the workplace or in the home. Petroleum products, those used in the dry cleaning industry, paint manufacturing, odours and gases of any sort are known to be irritants that promote headache when inhaled on a regular basis.
It is thought also that there are links to ratios of Oxygen and Carbon Dioxide. Where there is inadequate ventilation such as in air-conditioned offices or even in a bedroom with the windows closed problems can occur. Cigarette smoke, a known irritant is made all that worse when in a confined space. Discharge of vapours from perfumes and cleaning materials, even in minute quantities can affect some people.
Both the Migraineur and his or her GP should explore the possibility of medication overuse since it is a common cause of rebound and/or chronic daily headache. Symptoms are usually relieved after patients go through a “wash out” period of 8 weeks without taking daily medication, although symptoms often improve much sooner. Once the medication is withdrawn they may feel worse for anything from 2 days to 2 weeks before any improvement and some may need to seek professional help to manage their withdrawal symptoms.
Refs: A J Dowson, 2003 Oxford Health Press, 2002
