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Rebound headaches – When the “cure” is the cause

By Staff | Apr 7, 2009

Forty years ago I used to get headaches on a fairly regular basis. On these occasions, I took an over-the-counter headache drug to relieve the pain. Then I read an article that said such pain killers could cause kidney damage. I decided to stop taking anything at all for my headaches because I would rather live with headaches than without kidneys. The next time I got a headache I toughed it out. I went to bed and slept it off. About two weeks later I had another headache (I used to get them about twice a month on average.) I toughed this one out too. I’ve never had another headache since.

An Explanation for the Mystery

In the January 12, 2003, issue of the Sunday New York Times Magazine, there was an article called “Over-the-Counter Headache.” The author, Sandeep Jauhar, quoted Dr. Stephen Silberstein, director of the Jefferson Headache Center in Philadelphia, one of the country’s best headache clinics. Dr. Silberstein is also among the country’s leading headache experts and the senior editor of the most authoritative book in the field. According to Silberstein, about half of chronic daily headache patients develop the problem from20medication overuse. What is overuse? The article referred to research showing that over-the counter analgesics taken even five times a week can transform an episodic headache into a chronic one. Such headaches are called “rebound headaches.” Most people are not aware of this cause of headache. ” ‘It is a silent epidemic,’ ” according to Silberstein.

Why Americans Have More Headaches Than Other People

Such rebound headaches could be the reason that Americans appear to have more headaches than other people. The New York Times Magazine article cited studies in Africa and Japan showing headache rates one-third and one-half, respectively, that of the United States.

It was not until the early 1980s that experts warned that frequent use of non-narcotic analgesics could sustain chronic pain and that daily consumption of pain killers appeared to initiate a vicious cycle of tolerance and withdrawal, leading to even more use.

Why Headache Drugs Cause Headaches

Only recently have scientists found a neurological explanation for “over-the-counter headaches.” They theorize that a constant intake of analgesics lowers the brain’s level of serotonin, a neurotransmitter that inhibits pain-conducting cells. The effect is reversed when the drug is stopped.

It is becoming increasingly clear that seemingly benign drugs can have profound effects on the brain’s own pain-control pathways. Most scientists are now convinced that the overuse of medication can interfere with these pathways, paving the way for chronic headache syndromes. A vicious cycle is set in motion – headaches lead to drugs, drugs lead to headaches.

Only when the cycle is broken can the brain’s own pain-control system re-establish itself. A study at Harvard Medical School by Dr. Rami Burstein and colleagues has shown that stopping the chronic consumption of painkillers can help normalize function in some areas of the brain stem. But this normalization takes time; it might take several months to break the rebound-headache cycle.

The No-Drug Approach to Headaches

What can be done in the meantime to ease headache pain? For migraine headaches, remove triggers such as red wine, chocolate, aged cheeses, processed meats, monosodium glutamate (MSG), caffeine and aspartame. Stress, anxiety and too little sleep can also lead to migraines. One remedy is so simple that it is easy to dismiss. It is exercise – gentle, rhythmic exercises like swimming, biking and walking. Moving the body improves circulation and reduces stress, anxiety and depression. Another simple solution is magnesium. According to Earl Mindell, author of Prescription Alternatives, “If there had to be one magic bullet for both migraine and tension headaches, it would be the mineral magnesium.” He recommends 400 mg twice daily (one with breakfast and one before bed), But be careful. Too much magnesium can cause diarrhea. And last but not least, be patient.

This is the age of the quick fix. Although drugs can have symptom suppressing effects in the short term, they have these effects by interfering with the body’s normal functioning and healing processes. This interference is the cause of side effects. Sometimes the side effects are the very symptoms the drug is supposed to suppress: for example, laxatives can often worsen constipation. Sleeping pills can cause insomnia. And pain killers can cause more pain.

Mary Lou Williams, M. Ed., is a lecturer and writer in the field of nutrition. She welcomes inquiries. She can be reached at (239) 267-6480.