Rebound and Medication Overuse – New Perspectives

Rebound headache, medication overuse headache – these terms are bound to stir up controversy. How much medication is “too much”? How often is “too often”?

There are a few different ways to look at this. For example, there’s the official diagnosis, according to the International Headache Society’s classification. In that case, you have to be “overusing” for at least three months (and the definition of “overuse” is open to interpretation), and you have headache symptoms for at least 15 days a month.

This goes from a major problem to a severe problem – something like a drug addiction.

You can also look at it from a utilitarian point of view. What actually helps patients? Are there cases where a patient would be better off taking just a little more (not overdosing, of course!) instead of taking none of the offending medication? These things came up in a debate in 2016.

And which medications are dangerous, and which are not? Some list triptans very high on the list – others suggest they should be used more.

Finally, and perhaps most importantly, should we be thinking of this as a switch, or a scale? In other words, does medication overuse headache just “switch on” when you’ve taken one pill too many? Or is one more pill that much more of a problem?

Some are making the case that it’s much more of a scale, and that doctors are generally far too quick to increase the dose, to add another medication, or to skip non-drug treatments.

We’ll talk more about this next week, with some practical thoughts on the matter.