Miracle Moment: 3 Myths About Rebound Headaches

In this episode of The Miracle Moment, I review 3 Myths About Rebound Headaches.


[00:00:13] Hi everyone out there in MIGRAINE MIRACLE land. Welcome to the Migraine Miracle Moment. [5.7]

[00:00:19] I’m your host Dr. Josh Turknett. I’m a neurologist, a migraine specialist, migraine sufferer, and author of the book The Migraine Miracle, and the mission of this show the Miracle Moment is to help you find your path to migraine freedom without pills. [15.8]

[00:00:36] And in today’s episode I’m going to be sharing with you the three myths about rebound headaches. [6.2]

[00:00:43] So in the last two episodes we covered the “3 pillars of migraine freedom” and as a reminder those 3 pillars are 1) eliminating mismatched foods and behaviors by eating and living in a way that’s appropriate for a human, 2) establishing metabolic flexibility which is achieved largely through the elimination of processed foods and refined carbohydrates, and the third pillar eliminating rebound headaches. [29.2]

[00:01:13] And if you missed either of those two episodes you can find them in their entirety along with the full written transcript at mymigrainemiracle/moment. And that’s also linked in the show notes. [12.0]

[00:01:26] And today we’ll be exploring the topic of rebound headaches further. Specifically I’m going to cover 3 myths that commonly surround this subject, including the one myth that I think by far serves as the biggest hidden barrier to continued progression along the timeline of migraine freedom for most people. [20.4]

[00:01:47] And the reason I spend so much time talking about this subject and the reason I’m covering it today is because number one it’s such an enormous problem and number two it’s so often overlooked and neglected, and so many times it serves as a hidden barrier to progress. [18.6]

[00:02:06] As I said before even folks who are aware on some level of the concept of rebound headaches typically don’t appreciate the full spectrum of the impact of the abortive medications. And that was definitely true for me until fairly recently. [14.5]

[00:02:21] And I know the amazing things that can happen when you adopt the migraine miracle plan. And so one of the primary goals of this show is to try to eliminate any barriers that would prevent you from experiencing all those amazing things. [15.2]

[00:02:37] Speaking of experiencing amazing things with the Migraine Miracle plan let’s first celebrate our Beast Slayer of the Week. And so in each episode of The Miracle Moment we highlight somebody in our community who has recently dealt a mighty blow to the beast. [17.6]

[00:02:55] And this week it is April S. And this quote comes from our Facebook group. [7.6]

[00:03:03] April says “I brought Migraine Miracle to my last appointment and my records showing I went 45 days without a migraine, had weaned myself off of propranolol and down to one headache a week. [12.7]

[00:03:16] “She was so impressed she took a picture of the book to get her daughter. I was grain free and super low sugar before finding Migraine Miracle, but needed the additional strategies and supplements to quote get over the hump. [11.0]

[00:03:28] “So besides the fact that April here is doing really well – she’s going 45 days migraine free she’s weaned off one preventative and so on – she’s also sharing these results with her doctor, and her doctor here is not only receptive to what she’s doing but she wanted to share it with her own daughter as well. [17.9]

[00:03:47] And I know some people can be apprehensive about discussing these sorts of things with their doctor, but trust me the vast majority of my colleagues will be more than happy to hear of anything you’re doing for your migraines that’s making a positive difference. [15.1]

[00:04:02] Most docs are well aware that the conventional treatments that we have available are inadequate for a large number of people, which is a frustrating place to be in it when your job is to make people feel better. [12.6]

[00:04:15] So when you’re doing something that gets results unlike anything they’ve seen before in a condition like migraine that’s notoriously difficult to treat, then they’ll usually be more than happy to learn about it. And sharing your results with your doctor is also a great way to spread the message to others. [15.5]

[00:04:32] You can look for example at what happened with the gluten free movement. 10 years ago, hardly any of my colleagues could tell you even what gluten was or much less anything about gluten sensitivity or celiac disease. [17.1]

[00:04:49] Yet now many of them will routinely advise a trial of a gluten free diet for patients with a variety of intractable symptoms, and that change has has almost been entirely brought about by patients sharing their results with their doctors, in this case sharing the improvements they’ve had with a gluten free diet. [18.8]

[00:05:09] And that’s unlike the way things used to be where everything you know in medicine was top down. In other words the doctors learn something new from a journal or a new study or new guidelines put out by some medical governing body and then they would bring that to the patients. Nowadays patients are educating their doctors more than ever before. [19.7]

[00:05:29] And it’s the most effective way I think to bring about the changes that we all wish to see in health care. So kudos for April our Beast Slayer of the Week for sharing the Migraine Miracle plan and sharing her results with her doctor her. That simple action will likely help dozens or more people. [16.6]

[00:05:46] And for more inspiring stories of people who are now winning their battle against the migraine beast after years of struggle, head over to beastslayers.com. You can find that length in the show notes. [11.4]

[00:05:59] All right. So now it’s time for our main topic of discussion, which is the 3 Myths of Rebound Headaches. [7.2]

[00:06:06] So as I mentioned earlier rebound headaches and the negative impact of migraine medications in general is both an under-recognized and widely misunderstood issue. So in this episode I’m going to try to help clarify those misunderstandings a little further. [15.7]

[00:06:23] So the first myth of rebound headaches is that it’s only limited to one or two types of medications. I touched on this a little bit in the last episode on rebound but it’s worth repeating because it’s a question that comes up quite a bit. [14.8]

[00:06:38] And the mistake that I often see. So most people are familiar with rebound are probably aware that they can be caused by the triptan medications. [9.7]

[00:06:48] So the triptans are, for those of you don’t know, a class of eight different medications whose generic name all in the word “triptan. [7.9]

[00:06:56] The original one was sumatriptan which goes also by Imitrex as the brand name, and they’re specifically targeted towards migraine. And not surprisingly in many cases of rebound are a result of triptans since they’re one of the most commonly prescribed drugs for migraines. [16.1]

[00:07:13] And then probably the two the other two most common drugs that cause rebound are the combination analgesics, so things like Fioricet and Fiorinal here in the States, which combine caffeine with either acetaminophen or aspirin, and then butalbital which is a sedative. [21.7]

[00:07:35] And then the other type of medication would be the opiates or narcotic medications, which are the morphine derivatives like hydrocodone and oxycodone. Now the American Academy of Neurology strongly advise against using of the either of those two drugs for migraine patients – the combination pills or the opiates – and for good reason. [24.8]

[00:08:01] They both have the evil combination of number one not being especially effective against migraine, and then number two greatly increasing the vulnerability to future migraines. [11.1]

[00:08:12] And so why is that such an evil combination? Because people who take these are more likely going to need to take more for any given migraines since they don’t work all that well, and then it takes only a very little amount of them for people to end up in very bad shape with rebound. [15.2]

[00:08:28] So most people are aware that triptans can cause rebound and some are aware that these combination pills and the narcotics can do it as well. And those three are all prescription only drugs. [11.6]

[00:08:40] But the other important point is that any of the over-the-counter medications that are taken for migraine will also contribute. [7.0]

[00:08:48] So here’s a list of the drugs that we commonly encounter as causing rebound headaches. So this includes also aspirin. non-steroidal medications like ibuprofen, and acetaminophen or Tylenol, as well as other over-the-counter combination pills that are available. [23.1]

[00:09:12] Probably the most common ones that we see are Excedrin and Goody powder. And I see tons of people who are in really bad shape because of one of those. [9.7]

[00:09:22] And one of the reasons I bring this up is that very often during an encounter I’ll ask a patient you know about the medications they’re taking, and they may say that they’re hardly taking anything or they’re taking nothing at all. But in a surprising number of instances when I dig a little bit deeper I find that they’re not only taking an over-the-counter medication like Excedrin or ibuprofen or goody powder and so on, but many times they’re taking it nearly daily or daily. [29.3]

[00:09:52] And this after having just said that they are not taking anything. [3.4]

[00:09:56] So I think this just reflects a common bias towards thinking that the over-the-counter medications are somewhat benign or should be treated differently than prescription medications. And so they don’t really count the same. [12.8]

[00:10:09] But for our purposes here they absolutely do. [3.1]

[00:10:12] So don’t make the mistake of thinking they’re somehow less significant than the prescription medications. [5.4]

[00:10:19] So that’s the first myth. [0.9]

[00:10:20] The second myth is that only drugs or medications can help a migraine. [4.5]

[00:10:25] So it’s no secret that we live in a pill happy culture. We’ve been sold on the idea that modern medicines or pills will hold the solutions to our health problems. [10.5]

[00:10:36] But as we’ve learned in the vast majority of cases, they’re a crude and imprecise tool with all sorts of unintended consequences that we can’t even predict. And one of those unintended consequences when it comes to the migraine abortive medications is that each dose renders us more vulnerable to future headaches, and that effect adds up the more we take them. [22.9]

[00:10:59] So they may help in the short term but it renders us more vulnerable in the long term. [4.2]

[00:11:04] And this kind of pill first most men mentality is so pervasive that many of us don’t even see it. We can’t conceive that there could be other options besides medications. [10.4]

[00:11:15] And of course if you believe that medicines are the only option then naturally that’s what you’ll reach for each and every time the beast visits, which is one of the reasons we now find ourselves in an epidemic of chronic migraine. [13.0]

[00:11:29] But of course if you want to get out of rebound and if you want to minimize the need for medications in general then having strategies for helping and relieving a migraine that doesn’t involve the drug is extremely beneficial. [13.7]

[00:11:44] As some of you know, last year I spent several months conducting my own personal experiments with drug free remedies for migraines and ultimately created a guide of what I consider to be the best of the best strategies, and you can find that guide along with a downloadable migraine survival kit PDF by going to mymigrainemiracle/drugfree, which is also linked in the show notes. [26.2]

[00:12:11] And this topic also highlights what I think is a fundamental principle when it comes to anything we do for our health. [7.1]

[00:12:19] So with the drug free strategies we’re doing things that activate, support, or enhance our body’s own ability to heal and recover. [8.7]

[00:12:28] And in general, any health intervention that works in that way is going to be both more likely to be more effective and less likely to be harmful. [9.0]

[00:12:38] With the drugs on the other hand we’re typically disrupting these sensitive, finely tuned biological systems that are designed to keep us functioning up optimally. [9.0]

[00:12:47] And these are incredibly complex systems that we still aren’t close to fully understanding. [4.5]

[00:12:53] So in computer science terms when we’re taking medications we’re monkeying around with our source code without a true understanding of the full range of consequences of doing so. [9.6]

[00:13:03] So we should have an extremely high bar for anything we do or take that disrupts our physiology in this way, and kind of the primary scenario where drugs do make sense would be in diseases that have damaged one of our homeostatic systems in the body in a way that’s beyond repair, and so the only way to bring it back to some degree to normalcy is with medications. [24.6]

[00:13:28] So, for example, you know if you have a tumor in your pituitary gland that had to be removed, then if the gland is no longer there to secrete vital hormones then there’s no other choice but to replace those hormones with the drug. [13.6]

[00:13:43] But beyond those types of instances we should have an extremely high standard for Monkey monkeying around with our physiology in this way. [8.2]

[00:13:52] So that’s the second myth. And hopefully you’ll pick up the drug free guide if you haven’t already. [5.7]

[00:13:58] Then the third myth is that medications are only a problem if you’re in rebound. [6.4]

[00:14:05] And I think this is the biggest myth, the one that’s the hidden obstacle for the most number of people. [6.5]

[00:14:12] So a while back I published an article called the “7 Warning Signs You’re Having Rebound Headaches,” and that article is in the show notes as well. [9.7]

[00:14:22] And in that article I reviewed some of the classic features of rebound, and there mainly referring to the situation where someone is having frequent, oftentimes daily headaches, that won’t go away and that tend to have some very specific characteristics that distinguish them as being primarily the result of the medications. [21.8]

[00:14:45] But what’s described there is really the final stage of a process that’s been going on for quite some time. [6.7]

[00:14:52] And I think the central reason why we’ve failed to appreciate the full scope of the negative impact of the abortive medications is because we’ve been considering rebound headaches like I describe as the primary downside of taking them, and all of the recommendations about medications revolve around preventing someone from getting into that final situation. [21.2]

[00:15:14] However rebound headaches, at least as they’re typically thought about, are like I said kind of the end result of a problem that’s been escalating long before that situation has been reached. And so viewing it in this way ignores everything that happened that led up to that point. [17.6]

[00:15:32] So in other words we’ve been kind of thinking about it as a binary problem. Either you have rebound and you need to back off the medications, or you don’t and you’re fine. [9.8]

[00:15:43] And in retrospect this is kind of a silly way to think about it, because we know that biological systems, especially the nervous system, and the brain doesn’t work this way. [9.0]

[00:15:53] So the nervous system is always trying to maintain equilibrium. Anytime you disrupt it, it will try to restore that equilibrium back into balance. [8.8]

[00:16:02] And this principle was illustrated in the last miracle moment in between a SOAD and a put out on why medications are now my last resort. With the story about the firefighters so in that case the brain is down regulating its own pain regulation system in response to a consistent external source of pain relief. In this case the medications and if that process continues you end up in this worst case scenario where the medication has stopped working and your own systems for pain relief aren’t operating. [35.0]

[00:16:38] And so the equilibrium has been tipped heavily in favor of pain on the pain pleasure scale. [5.6]

[00:16:44] So the mistake here, the one that in my opinion has fueled an epidemic of chronic migraine, is in overlooking everything that’s happening prior to that worst case scenario. And so in seeing this as an all or nothing problem rather than a cumulative one. [15.6]

[00:17:01] And if we were to illustrate this graphically, here’s what the all or nothing view of medications would look like. [19.7]

[00:17:21] So on the X-axis here we see we have the frequency of medication being taken. And so as you move along increasing the amount taken initially there’s no effect you know on the on your vulnerability to future migraine, until you hit rebound territory. [17.7]

[00:17:40] And so this is kind of the all or nothing, or binary, view about it which is very misleading which gives you this impression that you know everything before this point where where things spike up with respect to our vulnerability, everything before that is OK. [16.7]

[00:17:57] And we were just trying to prevent ourselves from getting into that final situation. [4.9]

[00:18:03] But the more accurate way of looking at it is like this. So here we see that as our frequency of medication use increases, so does our vulnerability to migraine until ultimately we cross over the threshold where we’re stuck in this final stage of continuous pain because that equilibrium in the brain’s pain pleasure system has been tipped so far in the direction of pain. [34.1]

[00:18:38] And so from this more accurate depiction of it, it’s clear that this was the final stage of a process that had begun long before we hit rebound. [9.7]

[00:18:48] So our vulnerability to migraine and the pain pleasure scale was steadily moving in favor of the pain side until it finally reached this point where we hit that worst case scenario. So kind of reconceptualizing the effects of medications in this way was a big “aha” moment for me and has been a big breakthrough in being able to help more and more people reap the full benefits from the plan. [32.6]

[00:19:22] And it was a big reason why I spent a large part of last year trying to work on finding drug free strategies because I realized they’d be so important for people who were trying to get to that place. [11.5]

[00:19:34] And so you can see why with this more accurate view of the effects of medications that the risk benefit calculation of taking the abortive medications becomes very different. [11.0]

[00:19:46] So hopefully that gives you a more accurate picture of things when it comes to the medications, and the whole purpose of that is to kind of help you make a more informed decision about how to use them. [12.7]

[00:19:59] So that’s the third myth. [2.2]

[00:20:02] And with that we’re going to move on to our PRIMAL PROVISIONS PRIMAL Pick of the Week. [4.4]

[00:20:06] So for those of you who don’t know Primal Provisions is our weekly meal planning service where every Saturday we send out a Migraine Miracle meal plan along with recipes for all the meals, grocery lists, prep day instructions for people who want to prepare their meals for the week in advance. [17.6]

[00:20:25] And so it’s a really easy way of getting started with the Migraine Miracle plan, especially the food part, as it kind of takes all of the planning and decision making off the table and saves you time and anxiety, and helps ensure that you have great meals to eat throughout the week. [15.8]

[00:20:41] So this week’s winner is our Taco Burger with Lime Guacamole. [7.4]

[00:20:49] So I had the pleasure of eating this a couple of weeks ago and it’s fantastic. The lime guacamole topping in particular was the star of the show. [10.1]

[00:21:00] In fact the way I ate it it’s probably more accurate to say that the burger was the topping for my guacamole. I love guacamole to begin with but adding the lime to it just made it ridiculous. [11.9]

[00:21:13] So you can find that recipe at mymigrainemiracle/tacoburger, and that’s also linked in the show notes. And then to learn more about Primal Provisions, you can go to mymigrainemiracle.com/primalprovisions. [15.2]

[00:21:28] And I should also add that the Primal Provisions subscription, along with access to our entire archive of past issues and meal plans – which is something we recently created – is one of the many benefits that now come with membership to Migrai-Neverland which is our premier resource for migraineurs. [22.4]

[00:21:51] So membership there also includes access to our newly created Beast Slayer Training Academy, and we have our first group going through that right now, which has been a lot fun, and then unlimited access to all of our 30 day challenges, as well as our weekly group coaching sessions and more. [17.8]

[00:22:09] And the goal of Migrai-Neverland is is to help make finding your path to migraine freedom as foolproof as possible. And you can learn more about becoming a member at MYMIGRAINEMIRACLE.COM/ENDOFMIGRAINE. [13.8]

[00:22:24] So that’s it for today’s episode. [2.6]

[00:22:27] Once again, you can find all prior episodes of The Miracle Moment at mymigrainemiracle.com/moment, and I’ll be back again next Wednesday September 20th at 2:30 for another full length episode. [14.8]

[00:22:42] And you might see me before then with shorter in-between-isode. [4.2]

[00:22:47] Now go enjoy the rest of your day and SLAY THE BEAST! [3.5]