The Scale of the Problem
I don’t think it’s possible for me to understate the scale of the problem when it comes to rebound headaches.
Recently, in an effort to more precisely define the scope of the issue for myself, I did a chart audit to see just how many of my new patient referrals were having rebound headaches at the time of their initial consultation.
The answer? 80%.
That’s right. Incredibly, about 8 out of every 10 new patients referred to me for migraines were actually in the midst of rebound headaches when they first came to see me. And in many cases, their rebound headaches had been going on for years.
With numbers like that, I think it’s safe to say that rebound headaches are a gigantic problem. Making matters worse is that despite the fact that many of those 80% were actually aware of the phenomenon of rebound headaches, most of them didn’t realize that they themselves were actually experiencing them.
We health care providers have done a poor job of communicating exactly what they are, and how they can be identified. As a result, most of the time they go unrecognized.
And just why is it so important to recognize them? Because until rebound headaches are eliminated, no amount of diet, lifestyle, or medication changes are going to help.
I can’t emphasize this point enough. Until you break the rebound cycle, nothing else you do will matter.
So this is why when I sit down with a new patient who’s in rebound, my only priority is getting them to stop. I know from years of experience that if we don’t break these first, than all other efforts at migraine prevention are wasted. And if this happens, it then leads to the false conclusion that those diet and lifestyle changes don’t help with migraine prevention, and they may be cast aside forever.
The problem in these cases is not that these measures don’t help with migraine prevention, of course, it’s that they don’t get rid of rebound headaches. Migraine and rebound headaches are just two different animals, with different treatments.
It’d be like concluding that Ibuprofen is a worthless medication because it doesn’t lower your blood pressure. Hypertension isn’t the problem it was created to solve.
Surely, rebound headaches are the ultimate evil. The very thing you reach for to ease your suffering, your only potential salvation from grueling misery, transforms into the very source of that misery.
And it’s an incredibly counterintuitive concept to wrap your mind around, which is why rebound headaches are so insidious. How could something that’s your closest ally in one moment be your worst enemy in another? Surely it’s going to work this time, you think.
I know, I’ve been there.
Yet, this pharmacologic flip from friend to foe can happen in a heartbeat, and it takes surprisingly little medication to set it in motion. It’s important to remember that once set in motion, every single dose of medication taken for headache relief, even if it provides a temporary respite, will extend the life of your headache. And the longer you’re in rebound, the longer it takes to get out of it.
Clearly, recognizing rebound headaches as soon as they’ve begun is vital, so you can stop taking the very thing that’s adding fuel to the headache fire. With all that said, here’s how to spot them:
The 7 Warning Signs You’re Having Rebound Headaches
[message_box color=”blue”]What follows are 7 characteristics typical of rebound headaches. If your headache exhibits any one of them, it’s a red flag that you may be having rebound. More than one and it’s virtually guaranteed.[/message_box]
1. Your headache is present upon awakening.
Though migraines themselves have a tendency to occur first thing in the morning, this characteristic is especially true of rebound headaches, especially if you also had a headache the day prior. Rebound headaches typically present upon awakening or shortly thereafter, and then intensify as your activity increases.
2. Your headache has become exquisitely sensitive to movement, or physical activity.
One of the distinguishing features of rebound headaches are marked fluctuations in intensity, even over the span of a few minutes.
Whereas the escalation of a typical migraine is usually somewhat gradual, a rebound headache can ramp up from a 2 to a 10 with seemingly trivial physical activity (walking up a flight of stairs, bending over and picking something up, etc.), and in a matter of seconds.
3. Your headache pain is more spread out than usual, and oftentimes seems to concentrate in the back of your head, towards the base of the skull.
The location and character of the pain of a rebound headache is typically different than a “normal” migraine. Oftentimes, there will be features of the rebound on top of the typical migraine pain.
The pain of rebound headaches is often more diffuse, and tends to concentrate more in the back of the head, towards the base of the skull.
4. The medicine you usually take for headache relief has stopped working.
If you have you have “go to” medication for migraine relief that seems to have lost its punch, this is a clear sign you’re dealing with a different type of headache.
5. You’ve taken headache relief medicine more than two days in a row.
I’ve found that amongst folks who are familiar with the phenomenon of rebound headaches, few realize just how little medication it takes to get there. And this it’s why it’s so common for folks to have been in rebound headaches for years and to have never realized it.
For this reason, I don’t recommend any of my patients take medications for migraine relief more than 2 days out of the week. For some of you, this may not sound like much. But research shows this to be a critical threshold, and it’s supported by my own experience with patients.
Once you’re at this point, more medication is almost certain to compound the problem. This is why a solid prevention strategy must be the cornerstone of migraine treatment.
6. Your headache medication works for maybe a couple of hours, but then the pain returns, oftentimes stronger than before OR the headache INTENSIFIES shortly after taking medication.
This is an extraordinarily common pattern for rebound headaches. The medication you’ve been taking for relief works for a little while, but the headache reliably comes back after a couple hours or so. This pattern will usually continue indefinitely unless something is done to break it.
7. Your headache has become extremely sensitive to heightened emotion.
You find that just getting the least bit excited, upset, stressed, etc. causes a rapid escalation in your pain level. The mechanism behind this is likely linked to the one that underlies pain intensification with physical activity.
The one silver lining here is it affords you an opportunity to take advantage of those mindfulness techniques you’ve been practicing. 🙂
Now that you have the tools for recognizing when you’re in rebound, the next step, of course, is knowing what to do when that happens!
The first step is to stop making it worse – i.e., stop taking whatever medication you’ve been taking for headache relief that’s gotten you there. But what you can do beyond that to end a bout of rebound headaches will be the topic of the next article in this series.
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