Medication overuse causes headaches almost every day

Only one year after the first triptans were  marketed, there were migraineurs who were diagnosed with drug-induced headache. So it only takes a relatively short time to develop this distressing form of hedache. As a rule of thumb (and this is obviously only an indicative figure)  more than 10 triptan doses per month for a year is enough to develop medication-induced headache. Similarly, one can develop drug-induced headache by a consumption of about 37 doses of ergotamine and just over 100 doses of prescription drugs per month.

The headache you get from taking too much medication resembles migraines, but is is somewhat atypical and is called  a headache by the doctors.

Women are most vulnerable

Women are slightly more likely to develop drug-induced headache than men even after correction for there being more female migraineurs than there are male. We still do not know the exact mechanism behind the medicin induced headache, but there is certainly a genetic predisposition to it. Some people can take heaps of painkillers without getting medication-induced headache.

It also appears that a high consumption of triptans provide reduced response in the walls of blood vessels, and that serotonin production is affected. Serotonin is the common name for a variety of chemical substances that act as messengers from one nerve cell to another, primarily in the brain. It is assumed that a high consumption of analgesic drugs stop the body's ability to control feelings of pain, and you will instead experience a persistent pain sensation.

Do not take triptans 'preventive'!

Many migraine sufferers have a tendency to take triptans as a preventative - they are worried about whether they can cope with today's challenges and take 'just a pill.'  This often leads to an overuse and medication-induced headache.

Large consumption of painkillers with codeine can lead to true addiction. Some of the codeine is converted in the body into morphine, which gives a pleasant sensation.

1% of the population with medication-induced headache

There are probably between 2 and 5% of the adult population who have persistent headache or migraine, and 1% of the population has probably drug induced headache. Young people also develop medication-induced headache. Children as young as 6 years have been given this diagnosis. At the practitioner medication-induced headache is the third most common form of headache.

Patients with medication-induced headaches usually have been with several doctors and have a whole collection of prescriptions for different medicines.

The only way to be certain that you have medication-induced headache is through detoxification. If you get fewer migraine days after detoxification, there is certainly a large element of medication-induced headache.

Detoxification at home

Doctors recommend a cold turkey - sudden cessation of taking medication for migraine. It provides 3 to 10 days with severe migraine/headache. If you 'only' overuse triptans, it takes about 3 days before the migraine is gone. If you have had a mixed overuse of triptans and analgesics, it takes somewhat longer. Along the way, there may be nausea and vomiting, palpitations, sleep disturbances, agitation, anxiety and feelings of being nervous. There have been no studies with a gradual withdrawal.

It takes a brave patient to complete a detox at home. Patients taking sedatives should hardly be detoxed on my own. It requires a good deal of willpower to give up medicine, so only well-motivated patients have a reasonable success.

It is recommended that you begin preventative treatment 4 weeks prior to detoxification.

3 out of 4 patients have improved significantly after detoxification, and has a reduced consumption of acute medication. But one out of 5 migraineurs fall back into over-medication again in a few years.

H.-C. Diener and V. Limmroth, 2004. Medication-overuse headache: a worldwideproblem The Lancet Neurology 3, 475-483.