Are Your Meds Making Your Migraines Worse?

Do you wake up in the morning with a headache more often than not? Do you find yourself taking over-the-counter or prescription pain relievers more than three or four times a week? The medications you take for headaches are supposed to help ease your pain—but unfortunately, sometimes you can get into a cycle where those pain relievers do exactly the opposite. The result is what neurologists call “medication overuse headaches.”

If you get an occasional headache, or infrequent episodes of migraine headaches, taking over-the-counter pain relievers or doctor-prescribed migraine treatments like sumatriptan to “break” that headache isn’t a problem. But if you begin to have more frequent or more severe headaches, particularly migraines, the natural tendency is to take more and more of these medications. When they wear off, the headache gets worse again, and you take another dose to break it again.

But as this cycle continues, although you may be getting temporary relief, you’re ultimately developing more headaches. Your body is getting used to regular intake of these drugs, and it senses when they’re not around—triggering another headache, and spurring you to take still more pain relievers. If you’re taking medications to treat acute headache pain more than three days per week, it’s likely that you’re experiencing medication overuse headaches.

Overuse of medications can turn occasional migraines into chronic migraines, defined as having 15 or more headache days per month. In some cases, people develop status migrainosus, a disabling, long-lasting migraine that goes on for three days or more and may put you in the hospital.

The cycle of medication overuse headache is difficult to break, so ideally, we want to prevent it in the first place. If you’re experiencing frequent or long-lasting headaches, you should see a headache specialist who can prescribe daily preventive treatments that can reduce the frequency, duration and severity of migraines. These medications are different than those used to acutely break a headache, and do not cause medication overuse headache. 

Injections of botulinum toxin (Botox) have also proven very successful in migraine prevention, but most insurance companies require patients to experience at least 15 headache days per month and to have failed at least three other prescription treatments before they will cover it.

In addition to getting on an effective preventive regimen for migraines, you can ward off medication overuse headaches by:

• Limiting over-the-counter medications. Keep track of how often you’re taking medications for acute pain relief, and make sure it’s not more than three times per week. (A headache diary or smartphone app is helpful for this purpose.)
• Guarding your sleep. Migraines are notorious sleep thieves. It’s hard to know which came first—the migraine or the sleep disruption. But we do know that lack of sleep can trigger or worsen headaches. Set a regular schedule that allows for at least seven hours of shut-eye, keep electronics out of the bedroom, and avoid alcohol, caffeine and exercise later in the day. It’s also advised to talk with your doctor before starting a sleep medication, as some of these can also become addictive and contribute to more headaches.
• Cut caffeine. Limit your caffeine intake—that includes coffee, tea, soda and energy drinks—to no more than a cup a day. Caffeine acts in much the same way as acute headache medications, so while it may ease headache symptoms temporarily, you can get into another headache cycle by drinking too much of it.
• Don’t miss meals. It’s easy to do when you’re trying to get out the door for a busy day, but missing breakfast can worsen any type of headache. Try grabbing something small and portable, like a banana. Then keep your blood sugar levels stable throughout the day with smaller, more frequent meals.

If you’re already caught up in the excruciating cycle of medication overuse headaches, overcoming it is hard but doable. When you start cutting down, the headaches will initially get worse. Work with your doctor to develop a plan for this process, including establishing a preventive medication regimen if you aren’t on one already.

I recommend weaning yourself from the acute headache medications over a short period of time. Although stopping them cold turkey may be possible, this is not an option for all acute medications. If you are overusing prescription medications, you need to talk to your doctor about developing a weaning plan. Fioricet, for example, which is commonly prescribed for the treatment of headaches, contains a highly addictive agent called butalbital, a barbiturate. If you’ve been on this drug for a long time, stopping it abruptly may be dangerous. For other acute medications—whether you go “cold turkey” or cut down more slowly—your doctor may consider prescribing a short course of oral steroids, which can help bridge the gap and make the pain more tolerable. You can also use other non-medication headache remedies, including ice and heat packs and biofeedback, for temporary relief during this period.

Most people can expect that medication overuse headaches will start to get better about a week or two after “breaking up” with the acute headache medications, and continue to improve over the next several months. After that, it’s important to avoid falling back into the old pattern. Stick to your preventive regimen, keep track of your headache triggers and limit acute pain-relief medications to no more than twice a week. If you do that, the odds are that you’ve broken the cycle for good.

• Meet Dr. Svetlana Faktorovich, neurologist.
• One woman shares her experience dealing with migraines and what she wants others to know about being a migraine sufferer.
• Learn more about Northwell Health's Headache Center.