Headache

Migraine Headache    
Tension-Type Headache
Rebound Headache

Rebound Headache
Symptoms
How to Make a Diagnosis of Rebound Headache
The Causes of Rebound Headache
Treatments

Symptoms of rebound headache include:

	daily or nearly daily headache
	pain on both sides of the head
	pressing/tightening quality ("like a tight belt around my head")
	perhaps a mild degree of photophobia (sensitivity to light) or phonophobia (sensitivity to sound)
	tight and tender neck and shoulder muscles
	the patient is regularly taking symptomatic/abortive pain medication

It is important to realize that Rebound Headache is a SYNDROME and is NOT one particular type of headache that a patient suffers.

How to Make a Diagnosis of Rebound Headache

Rebound headache most often develops in a migraine patient. Typically, the migraine headaches gradually become more and more frequent over several months with a gradual change in the type of headache: The migraine headache happens less often and is replaced by a tension-type headache, which becomes a daily occurence.

A common scenario in rebound headache patients is the following:

	for some reason (sometimes increased stress), the migraine worsens;
	the patient ingests more and more of their symptomatic/abortive migraine headache medication;
	eventually, the patient's medication becomes less and less effective;
	gradually, a daily or near daily tension-type headache develops often accompanied by periodic, severe migraine headache.

The Causes of Rebound Headache
Abnormalities in the body that cause rebound headache are not known. Up to 40-70% of patients seeking care at headache or pain clinics are thought to be suffering from this syndrome. It probably is a rather common problem, but it is under-recognized by doctors.

What Drugs Can Cause Rebound Headache?
Many headache specialists believe that any abortive/symptomatic headache medication can cause rebound headache; the most common culprits are actually the over-the-counter medications!

What is Too Much Symptomatic/Abortive Medication?
The number of times a person with a history of migraine can ingest symptomatic/abortive medication is not clear. Many authorities now suggest that migraine patients take no more than a total of 10 doses of symptomatic/abortive medication per month. Others allow more but become concerned about rebound when abortive therapy is needed more than a few times per week.

Treatments for Rebound Headache

Stop the Culprit Drug
If patients with rebound headache stop taking the drug(s) that are causing the syndrome, in 4-8 weeks 80% note dramatic improvement -- without doing anything else! However, for many patients, the initial few weeks may result in a worsening of their headache.

If the culprit medication is not stopped, additional treatments often will have very limited benefit. Studies have shown that a prophylactic headache medication often will not have a beneficial anti-headache effect when given to a patient that is rebounding. Therefore, when a rebound headache patient tells the doctor that he/she "has tried every headache medication known to man," more likely than not the prophylactic medications were prescribed while the patient was in the rebound cycle, and thus the drugs were not given an adequate drug trial.

Prophylactic Headache Medication
In addition to stopping the symptomatic/abortive drugs, some patients may benefit from addition of a prophylactic medication, such as an antidepressant.

Stress Management
An important element in treating rebound headache is helping the patient rid him/herself of the knee-jerk reaction to take a medication at the first sign of head pain. Techniques such as relaxation, imagery, and biofeedback can be helpful.

Biofeedback
Biofeedback may be an effective treatment for rebound headache.

Physical Therapy
Aerobic conditioning, neck and shoulder muscle stretches, craniosacral manipulation, and massage may help.

Headache/Pain Clinic Treatment
Rebound headache patients are often difficult to treat and require a multidisciplinary approach, including strict medication management, stress management training, and physical therapy modalities, all of which can be provided in a headache or pain clinic.