My husband has suffered from headaches for years, and is constantly medicating himself with paracetamol, codeine and ibuprofen, although he is careful with his dosage and not taking codeine for more than two days in a row. I read about medication headaches and I wonder could this be the cause of his problems. How likely is this?
You are right to think that your husbands regular use of over-the-counter (OTC) medication could very well be causing rebound (medication overuse) headache. Rebound headaches are caused by taking OTC pain relief medication for more than a couple of days a week for an extended period, potentially years in your husbands case. The definition states use of OTC pain medication for 15 days per month for three or more months. Although not a primary headache disorder in itself, it frequently co-exists with a primary chronic daily headache disorder such as tension-type headache or chronic migraine headaches.
In chronic migraine sufferers, the risk of developing medication overuse headache is increased with older age, smoking and symptoms of anxiety/depression. The potential clues to rebound headache include the headache occurs daily, may wake you from sleep and gets somewhat better with medication but always gets worse as the medication begins to wear off.
The good news is that this type of headache disorder generally settles down simply by stopping all medication. Detoxing takes about one week and occasionally can persist for two to four weeks, but by attending a GP you can get medication that does not cause rebound headache to help reduce the withdrawal effects. This is called transitional or bridge therapy and is only prescribed for a few weeks.
Before your husband embarks on this challenge he should address the common sense triggers for headaches such as stress, poor sleep, not eating healthy food regularly, not hydrating well every day, not getting daily exercise, drinking too much caffeine, smoking cigarettes and carrying too much weight. All these factors can make anyone more prone to chronic daily headaches. If he has an underlying element of depression or anxiety, he would benefit greatly from attending a psychotherapist for cognitive behavioural therapy.
Another good thing to do is keep a headache diary which can help you identify any possible triggers and help create positive behavioural change. In the diary try to record the time of onset of the headache, duration and severity, note what you were doing, eating or drinking before the headache began. Smartphone apps have been created to help with this.
Following cessation of all medication, it would be worthwhile attending a doctor to get an understanding of the possible underlying headache disorder. Other potential headache disorders include cluster headache. This is an intense headache that lasts from about 20 minutes to a few hours. It tends to occur in bouts, such that you may experience this pain several times per day for a period of a few weeks and then it may go away for months or even years.
Sinus headache is common when the pain is present in the face, behind or above the eye region or sinuses and has the character of a sinus pressure which gets worse on bending your head forward. After working with a doctor it will become clear if your husband warrants further investigations by referral to a headache clinic. At the clinic, a consultant neurologist may consider brain imaging in the form of an MRI or MRA (angiogram) as well as possible lumbar puncture in certain rare situations where high or low pressure in the brain may be a contributing factor.
Dr Jennifer Grant is a GP with Beacon HealthCheck
