Headaches on the Rebound After years of daily headaches I found out about the rebound effect, when the medication becomes the problem.

Headaches on the Rebound

By Ann Green

I’m on the rebound from a long-term relationship with endless headaches.

The headaches started at least 15 years ago (I don’t remember exactly), and they kept on coming.  Daily.  Tylenol made the pain go away.  Because of a severe allergic reaction to aspirin when I was a child, I was afraid to take anything remotely related to aspirin.  After a while it was as though I had a constant headache, with breaks allowed by Tylenol.  It was not uncommon for me to wake up at 3 a.m. with a headache.  There were no specific triggers, except for alcohol, which I gave up years ago, and which in any form whatsoever gave me an instant migraine.  (Migraine and chronic headaches are not the same thing, although if you have one you are likely to have the other.) 

The pain made its home all over -- my jaw, teeth, face, the sides or middle of my head.  Sometimes I’d get a sharp pain in the temple.  I mentioned the jaw pain to a dentist, wondering if it might be TMJ.  He announced, “That’s absolutely TMJ!” and sent me to an oral surgeon who said that it wasn’t.  A neurologist told me that my neck muscles were too tight and that I should apply heat. 

As for unsolicited advice, I’ve heard it all: go gluten-free, try Reiki, find a chiropractor, get acupuncture, learn relaxation techniques, change your pillow, give up caffeine, meditate.   Frequent suggestions that the headaches might be “stress-related” sounded to me like, “If you just calmed down, you’d be fine.” 

And on and on it went.  For seven years I saw a neurologist at a top Boston hospital’s headache clinic.  Before I started they had me do a sleep study, which found nothing.  With this doctor I tried endless combinations of preventative medications to no avail.  This included Botox treatments  in my scalp.  With a diagnosis of “refractory (resistant to treatment) migraine, neck pain and muscle spasm,” I quit the clinic.  I joked to people that I had flunked out.  I then tried cranial sacral physical therapy, with no effect.

Relief came from an unexpected source.  I met someone who has similar problems.  She mentioned something called “the rebound effect,” when large amounts of medication cause or exacerbate the problem.  I read an interview with California neurologist Dr. Allan Bernstein on a website called Life Matters. Bernstein said that daily headaches and daily use of painkillers were the major indicators of rebound headache.  People with a history of migraines seem to have a brain chemistry that handles painkiller differently in their systems.  I was also increasingly aware of the dangers of too much Tylenol, liver problems first and foremost. 

Soon after, I went to a third neurologist, who read through my files from the headache clinic and was amazed at the array of drugs we’d tried.  She was surprised that I hadn’t had an MRI, although this is fine with me because I’ll never find a cure for my claustrophobia.  I asked about the rebound effect.  She was firm about getting rid of the Tylenol and gave me a substitute, Maxalt.  She said I shouldn’t take either one more than twice a week.  This sounded to me like an order to run a marathon.  Backwards.  She also suggested going off all forms of caffeine -- coffee, tea and chocolate were mentioned specifically.  Three of the best things on earth.  I agreed.  That’s desperation.

The next two days were among the worst of my life.  Banging head pain coupled with intense anxiety.  Toward the end of those two days I took a Tylenol.  I did not take one for another three days.  Now it’s been a month.  The pain is dramatically reduced.  I occasionally feel some discomfort, but I ride it out.  I hesitate to call myself cured, but I’m hopeful.  The caffeine ban is still in effect.  Sigh. 

When did the medication replace the headaches as the major problem?  I have no idea (chicken or the egg?).  I implore anyone in a similar situation to consider whether or not you, too, are on the rebound.