For most people battling chronic migraines, kicking rebound headaches are first priority, and the first step for many of our Migrai-Neverland members.
Conquering them on your own can be a daunting, if not IMPOSSIBLE, challenge. Which is why all too often they go on for years, or even decades.
So nothing pleases us more than seeing our Migrai-Neverland members win their rebound headache battle.
One of the best avenues for helping them to do so has been our weekly group coaching sessions, aka the “clinic chat.”
For some, just one single nugget of information in these sessions has given them the “aha” moment they needed to win their battle.
(RELATED: The Chatter, our weekly transcript of each coaching session, is now available to non-members. Click here to learn more about becoming a subscriber.).
Since rebound headaches are probably our hottest topic, we’ve compiled a sneak peak of some of our most “Frequently Asked Questions” about them.
FAQs on Rebound Headaches:
Q: When Will I Know I’m Out of Rebound? How many days should pass without a headache to know I’ve broken the cycle? As I am prone to have a headache with over exertion (even a gentle yoga class will set it off with one downward dog), I’m wondering when I can safely resume moderate exercise.
A: That’s somewhat of a tricky question, as it will in part depend on how long you’ve been in rebound, and what kind of medication consumption pattern you’ve had during that period.
But the brain has to reach a new equilibrium that no longer includes the med or meds you’ve been taking.
Generally speaking, 5-7 headache free days is an indication that you’re mostly through it, but not likely to be back at equilibrium.
Q: Will walking by itself make your migraine pound? I usually try to walk while in migraine and stretch…but I avoid stuff the elevates my head above body.
A: If your head still hurts after bending, downward dog (a great litmus test for rebound!), then that’s a pretty good sign it’s still there.
There’s likely some degree of hypersensitivity that lingers for weeks to months; the literature on rebound says up to 6 months for full recovery.
Q: Yikes! 6 months!! Is there a list you’ve made somewhere that gives us ideas for coping with long rebound in as healthy a way as possible to get it over with as quickly as possible? Does that mean 6 mos. with no meds to fully recover? So during the 6 months… I should not take any more medication?
A: The first goal I typically have for patients who’ve been in rebound for long periods is to get to 2 days a week or less of abortive medication, since that seems to be the critical threshold for getting into rebound to begin with.
Q: So if I’m on day #5 right now of this headache, should I try to abort or continue to suffer hoping I’m going to break a cycle?
A: You don’t have to bite off the entire rebound animal in one bite, but simply having an awareness of its huge, and continually working on getting out of the cycle.
I think it’s fine to take something if you’re desperate. It’ll ultimately prolong the time to recovery, but if it helps you get there and maintain your sanity, then that’s ok too. Aim primarily for progress (less abortive medication over time).
Q: Once you are out of/or at least think/hope, that you are out of rebound. Will a 5 day Migraine after a 12 day headache free period, put you right back into it? If so, how can you prevent that from happening?
A: I like to say that rebound is hard to get out of, and easy to get back into. Also, the longer you’ve been in it, the longer it may take to get out of it entirely. If someone has consumed abortive medications fairly regularly for an extended period, for example, it’s likely that the brain needs weeks to months to reach an equilibrium that no longer bears any influence from those medications.
But rather than think in terms of absolute numbers, I think it’s more helpful to think of rebound as existing on a continuum – in other words, every time you take something for migraine relief, it renders you a bit more susceptible to another migraine over the next several days. Add in another dose of medication during that span, and the effect increases. This is not to say that abortive medications don’t have their place, it’s just that it’s very important to be mindful of these effects to help guide decision making.
The key for me with abortive medications is to aim for the minimum necessary, and to recognize when you’ve hit a state when they’re doing more harm than good (i.e. take something and it doesn’t work, or works for a short period and then the pain returns the same or worse, etc.).
Q: I am confused about getting out of rebound. Isn’t it necessary to quit all meds in order to get lasting relief? And how do you know when it is safe to take triptans or OTC drugs again? Does the diet help to get you out of rebound?
A: So, the quickest way to get out of rebound is to stop everything….
That said, that can be quite challenging, especially in certain circumstances, so this is what I usually tell folks:
You don’t have to conquer it all in one fell swoop. The key is to make consistent PROGRESS over time – in other words, if you’ve been taking 30 excedrin per week for a month and you go through a week and only take 10, then you’ve closer to your goal.
It may take you longer to get there that way, but taking something to help you make it, even if it results in a temporary setback, so that you can get closer to your ultimate goal. And yes, the diet definitely helps reach that goal faster.
Q: So 2.5 weeks with no migraine, have you broken rebound?
A: I’d say most likely you have. This will depend a bit on how long you’ve been in it, what meds got you there, and what specific meds they were, but 2.5 weeks means you’ve broken the lion’s share of it
Q: Does my preventative Atenolol encourage some sort of dependency cycle or is only relief medications.
A: As far as we know, the main issue is with the relief medications.
And not a silly question at all – probably one that’s worthy of further study
Q: I have the same kind of question: Do the preventative meds have rebound as well?
A: It doesn’t seem to be the case, but it’s not something that’s really been scientifically tested.