First, let’s recap part one.
Here are the 7 Warning Signs You’re Having Rebound Headaches:
1. Your headache is present upon awakening.
2. Your headache has become exquisitely sensitive to movement, or physical activity.
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.
4. The medicine you usually take for headache relief has stopped working.
5. You’ve taken headache relief medicine more than two days in a row.
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.
7. Your headache has become extremely sensitive to heightened emotion.
I imagine that many of you out there, after reading through the above list of warning signs, are thinking I can relate to some of those.
As I said in the first post, it’s hard for me to overemphasize the scale of the problem with rebound headaches. And the longer I do this, the more patients I see, the more I realize what an enormous impediment they are between you and lasting freedom from migraines.
So, then, if you find yourself in the midst of rebound headaches, whether they’ve been going on for weeks, months, or years (not uncommon at all), what on earth do you do about them?
The first step is obvious.
Obvious, but not at all easy. And that is to…
1. Stop taking the medications you’ve been using for migraine relief.
You’ve got to get off the train that brought you here. Of course, that’s a tall order, right? Not reaching for something for relief when your head is pounding is a monumental feat of willpower and courage.
But an absolutely necessary one.
And, ultimately, it’s a good habit to form, one that’s critical to your ultimate goal of migraine freedom. You don’t want to be in the habit of reflexively grabbing for something when your head starts to hurt.
Rather, you want to first reflect for a second on your recent actions to assess whether you’re already teetering on the edge of rebound land.
You want to make sure that the medicine you reach for is solving a problem, not making it worse.[message_box color=”blue”]
WHAT MEDICATIONS ARE THE WORST FOR CAUSING REBOUND?
Generally speaking, there are certain medications where rebound headaches tend to develop more quickly and easily.
This seems to be based on two primary factors:
1) Intrinsic properties of the medication, and
2) How effective it is at relieving migraines, which boils down to how migraine specific it is.
Over the counter, the worst offenders are the combination meds with caffeine (Excedrin, Goody’s, BC, etc. then followed by the other general analgesics).
For drugs that require a prescription, the worst for causing rebound are Fioricet (aspirin/butalbital/caffeine) and the narcotic family of meds (hydrocodone, oxycodone, etc.).
The narcotic meds are particularly evil and insidious, which is why the American Academy of Neurology specifically advises against their use in the treatment of migraine.
Lastly, there are the migraine specific medications: the Ergots and Triptans. Both can lead to rebound, especially when you pass the 1-2 days per week threshold.
But they have the advantage of being the most effective medications for migraine relief, which means the lowest chance of needing another dose amongst all the choices (in fact, the triptans are so migraine specific that if you take one and don’t experience any relief, this is a pretty good sign you’re already in rebound).[/message_box]
I know, I wish there was an easier way, a shortcut to getting out of rebound that didn’t require this step. Alas, there is not.
But remember, we’re enduring a short term pain for a long term gain here.
(If you do reach a point where you just can’t cope any longer, then make sure that if you do take something, you take a highly effective, migraine specific remedy. Just keep in mind that every medication taken while in rebound will ultimately prolong the amount of time it takes you to finally break the rebound pattern. So don’t rob Peter to pay Paul unless you absolutely must.)
That said, there are things you can do to make the transition out of rebound headaches easier. I will oftentimes prescribe a short tapering dose of an oral steroid to patients who are abstaining from their as needed headache medication. For most, this will help ease the transition, and so is something you can check with your doctor about.
Beyond that, the best thing you can do to move things along is…
2. Live like a monk until you’ve broken the pattern.
A monk? Allow me to elaborate.
First, let’s review some of the things migraines need to stay alive and grow:
1) Sugar. Specifically, glucose. Remember that sugar is migraine fuel – the more sugar available to the brain, the more fuel for the migraine fire. The less sugar, the less strongly it can burn.
This is likely one reason why the evidence continues to mount in favor of ketogenic diets (where the brain can use ketones as an alternate fuel source to sugar) as a powerful strategy for migraine prevention.
Sugary foods are typically consumed for their hedonistic value. In other words, we eat them cause they make us feel good.
As a monk, however, you now derive pleasure through inner peace and enlightenment, not cheap gustatory thrills.
So absolutely no sweets, sodas, or processed foods of any sort. And no fruit, rice, potatoes, or any food high in easily digestible carbohydrates, either. All you’re doing if you do is throwing more logs on the fire. We want to starve the migraine, not feed it.
2) Hormonal fluctuations. Especially sharp rises in stress hormones.
Stress hormones are bad, bad news when trying to conquer rebound headaches. Stress hormones cause the body to release…..wait for it…..sugar into bloodstream (sugar exists in storage forms in the liver and muscles so it can be mobilized during these times).
And what sorts of things prompt the release of stress hormones?
The biggies are sleep deprivation, emotional upset, strenuous (high intensity) physical activity, and meals high in refined carbohydrates (thanks to the ensuing blood sugar crash that occurs in response).
So, to avoid surges in stress hormones, you want to:
a) Get plenty of rest, at the right time.
Monks live their lives by the rise and fall of sun. You know, the way every single one of us is biologically programmed to do.
Sleep is absolutely essential to good health, happiness, and migraine freedom.
And insomnia is yet another artifact of modern living, not a feature of your own personal biology. For most everyone, it can be conquered with lifestyle changes.
Come to think of it, I don’t know any monk insomniacs.
b) Avoid emotional turmoil.
There’s a reason I’m always celebrating the benefits of mindfulness practice – the ability to observe one’s thoughts without reaction.
In this day and age, the single biggest driver of our stress response is not actual real, live threats to our survival (the very reason that stress response exists). The single biggest driver is our thoughts.
And one of the best ways to break the spell your thoughts have over you and your physiology is through mindfulness practice. It’s something monks spend much of their days doing. Not coincidentally, they are regarded as masters of emotional regulation.
Dissociating thoughts from emotions is one of the greatest gifts you’ll ever give yourself, and the key to emotional stability. Oh, and lasting happiness.
Remember, you can’t control everything that happens to you, but you can control how you respond to it.
We modern day humans have developed some strange ideas about going without food for any significant length of time. Despite the fact that the typical human with the ideal amount of body fat is perfectly capable of meeting his or her energy needs for at least a month using nothing but that stored fat, we still have the hardest time believing that the “3 meals a day” routine is not a biological imperative.
IT IS NOT A BIOLOGICAL IMPERATIVE.
In fact, it’s a very recent cultural phenomenon.
Our guts are far more like that of carnivorous animals like dogs and wolves than ruminant herbivores like cows and goats. The former eats after a kill, and then may go long periods of time without eating again. The latter eats all day long. We’re not built for grazing, yet grazing has become the cultural norm.
But rest assured, you’re perfectly capable of divorcing yourself from the 3-meals-a-day routine. And, as a general rule of health, you’re much better off following your body’s cues as opposed to cultural conventions.
Moreover, the evidence continues to mount in support of the health benefits of fasting. This may explain why fasting has been idenitified as one of the common features amongst “blue zone” communities – those pockets around the world where people live far longer than their neighbors, where centegarians aren’t a rarity.
And here’s a great TED talk courtesy of Mark Mattson, chief of the Neuroscience Lab at the National Institute of Aging, on the brain benefits of fasting (if you have a history of neurodegenerative illness like Alzheimers or Parkinsons in your family, it’s worth taking a listen).
Suffice to say that there are ample reasons to fast (and, specifically, to employ what’s known as “intermittent fasting“), at least from time to time, even without migraine relief as a motivator.
But if you are in the midst of a bad bout of rebound headaches, fasting is one of your greatest allies. There’s no better way to avoid blood sugar spikes and the attendant surge of stress hormones than to simply not put food into your stomach.
Plus, the longer you go, the more neuroprotective ketone bodies your liver will produce that can then travel to the brain and snuff out the migraine fire.
Aim for 16 hours (so if you’re dinner ends at 7 pm, your next meal should be after 11am). Even if you don’t fast, just minimizing caloric intake is helpful.
And when you do eat, minimize carb intake – remember, what you really wish to avoid are fluctuations in blood sugar. So, go for high fat, moderate protein, and very low carb until the rebound headaches have broken – this type of eating will maintain your physiology close to the fasting state (where blood sugar is stable, and fat is easily mobilized and burned to meet energy demands).
And those are the essentials.
Release your inner monk until the headache is broken. The robe is optional.
A Final Word About Rebound (warning: soap box rant ahead)
As evil as the phenomenon of rebound headaches seems (that the very thing that saves you one minute could harm you in the future), I think that they provide an extraordinarily valuable lesson about how our body works, and the best way for us to take care of it.
One of the universal principles of biology is that of adaptation. The body seeks equilibrium in all things – meaning if you disturb the body somehow, it typically responds by doing everything it can to return to its prior state.
Imagine for a moment that your job is to take the trash out to the street every morning, but one morning you walk outside to find someone has already taken it out there for you. The next morning, same thing. And the next morning. And the next.
In response, do you
a) start waking up earlier so that you can take it out yourself, or
b) use the time you’ve now saved from not having to take the trash out to get something else done?
Most rational humans will choose b. The human body and brain follows the same logic.
This means that if you disrupt a bodily system with an external input (i.e. a drug/medicine), the body will try to modify that system so that things return to baseline, with that drug or medicine now incorporated.
For example, the body has its own intricate system for pain control (this is the very reason we have morphine receptors in our brain). If you consistently introduce a foreign substance like a pain suppressing medication into that system, the body will adapt over time, ultimately down-regulating its own system for suppressing pain. Eventually, things return back to where they were before you introduced the foreign substance.
So now you’ve reached the point where your pain is no better than it was when you started, yet you’ve become dependent on the medication just to feel the same as you did before you took it to begin with.
You’re no better off than you were when you started, plus you have to take a drug every day just so you don’t feel WORSE than you did when you started.
The drug has obliterated your body’s own pain management system. Your body, being the logical and efficient machine that it is, stopped taking out the trash, because someone else had taken over that job.
The same general principle applies to the neurotransmitter systems that are targeted by drugs for mood and behavioral regulation. And this phenomenon of adaptation is likely the primary reason that rates of mental illness have exploded in the era of psychopharmaceuticals (the rate of mental illness in the U.S. has risen over 500% since the introduction of psychiatric medication) and the drug-industry promoted concept of mental illness as a “chemical imbalance.”
In these situations, medications can provide a short term fix, but in the long run will worsen the very problem they were given to solve.
What’s the solution, then?
To take a holistic view of the human body, and to recognize our own interventional limitations. Our body is an incredible self-healing machine, generally FAR better than we are at fixing itself.
Most of the time, we can’t outsmart the human body, because we just aren’t that smart. Nor do we have the proper tools, even though we (we meaning the modern health care system) behave like we do.
The best treatments are those that leverage the body’s ability to fix itself. The best treatments address root causes; figuring out why the body has malfunctioned to begin with, and assisting it in returning to its healthy baseline.
That’s harder to do, for sure. It’s not the quick fix most people expect or want these days, nor is it how modern medicine is currently practiced.
There’s a reason the United States spends about twice as much per capita on health care compared to other nations in the developed world, yet has the worst outcomes. The effects of our quick-fix, pill-popping mentality are glaringly obvious.
At this point, the wake up calls are nearly deafening. The question is: will we keep sleeping through them?
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