News anchors, journalists and medical websites have warned that “painkillers might be causing your pain!” too many times to count. OK, OK, rebound headaches are nasty; so are chronic daily headaches and migraines. I want to know how much is too much. Not vague amounts, but clear, precise doses.
In comes the conflicting advice. One doctor said to rotate Imitrex, Migranal and Advil every three days to avoid rebounds. Another said that it’s perfectly fine to take a triptan a couple days a week and an OTC painkiller another few days. Of course, no doctor knew just how much Advil I took because I was afraid to admit the amount to myself, much less say it out loud.
When dignity took a backseat to pain relief, I stopped the painkillers. Four years later, I can barely remember how much better I felt when I took occasional painkillers. I often forget that it’s even an option. But I do remember my headache specialist telling me that the goal of my treatment is to make me feel like I do when I take Advil*. Lately, the forbidden drug has started calling my name.
Because my headache specialist, who I think is terrific, relies on the International Headache Association’s standards, I’ll do the same. IHS’s bottom line is that rebounds are likely if you take painkillers or migraine abortants more than once or twice a week or more than 10 times a month. As you well know, nothing is one size fits all, but these are good guidelines.
Think you might be in rebound? Here are some frequently prescribed meds that can cause rebound headaches. You’ll be miserable if you stop them cold turkey, so get your doc’s advice first.
Triptans: Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig
Ergots: Cafergot, D.H.E. 45, Migranal, Sansert
OTC Painkillers: Acetaminophen (Tylenol, Excedrin, Vanquish), Asprin (Bayer, Bufferin), Ibuprofen (Advil, Motrin), Naproxen Sodium (Aleve)
Prescription NSAIDs: Indomethacin (Indocin), Ketorolac Tromethamine (Toradol), Naproxen Sodium (Anaprox, Naprelan, Naprosyn), Piroxicam (Feldene)
Opioids: Fentanyl (Duragesic, Actiq), Hydrocodone (Vicodin, Lortab, Lorcet, Norco), Morphine (MSIR, MS Contin, Oramorph), Oxycodone (Roxicodone, OxyContin, OxyFast, OxyIR)
The scariest part about stopping the meds is that your headaches might not change or may even worsen.The underlying condition that prompted you to take them in the first place is probably still there. Even if you don’t get immediate relief, your headaches may be easier to treat in the long run with fewer drugs getting in the way. And your kidneys will thank you.
*Advil doesn’t get rid of my headaches, but it sometimes reduces the severity of the pain. For me, feeling “much better” is having pain that’s below threshold that would keep me in bed.