Headache medication – why less may be more

Strange but (sadly) true: medicines you take for headache relief can cause headaches. The reason is the way the central nervous system (CNS) adjusts and self-regulates. If you use pain relief medication for a long time, your CNS lowers your pain threshold and you become more sensitive to pain. Your CNS does this to restore your original, ‘normal’ level of pain sensitivity. That is why stopping pain medication after long-term use may trigger an agonizing “rebound” (withdrawal) headache. Taking painkillers to treat that pain can catch you in an endless cycle of worsening pain and increasing medication use, ultimately resulting in medication overuse headache. The good news is: you can do something to stop it.

Prevention with the 10-20 rule

The 10-20 rule is an effective way to avoid getting medication-overuse headache. In any one-month period, do not take pain medication on more than 10 days. Regardless of dose. Use no pain medication whatsoever on the other 20 days of the month. This means it is better to take an effective dose on one single day than take too little on several days.

Tracking your medication use for a month will help you apply the 10-20 rule. Record each dose in your planner or drug diary (the app is ideal). This will show you whether you are in the safe zone in a given period or need to take extra care. If you obey the 10-20 rule, your nervous system will be less likely to increase your pain sensitivity. And your headache remedies will remain effective.

It pays to take a break: have a “drug holiday”

If you do develop a medication-overuse headache, your pain sensitivity levels need to be re-set to normal. This requires a medication break under medical supervision. Your healthcare team will probably recommend a “drug holiday”. The most effective setting for a drug holiday is a specialist clinic where you will have continued access to the best medical care for an approximately two-week period. Treatment will refill your brain’s stores of the special natural chemicals (neurotransmitters) that play a role in pain perception. Overuse of pain medication uses up these neurotransmitters.

Patients on drug holidays receive supportive treatment that enables them to manage their headaches without drugs in future. Lifestyle modification for headache prevention takes center stage. A drug holiday with medical support and supervision does a lot to improve patient well-being. “Re-setting” your pain perception will give you back control over your headache and help you get your life back.

The goal: avoid medication as much as possible

Integrating good habits into your life will help reduce your medication use to your personal minimum. If you can avoid getting caught in the vicious cycle of pain and medication use, you will escape the distressing effects of a medication-overuse headache. You will also avoid the other side effects of taking painkillers, some of which are serious. The effort is worth it because it means your medication remains effective and you can enjoy a more carefree, pain-free life.

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