Preventing and Managing Medication-overuse/rebound Headache*

Rebound headache occurs when patients are overusing medication to treat individual headache attacks; this overuse of medication causes an increase in headache frequency. A cardinal sign of rebound headache is progression from episodic to daily or near-daily headache. This continuum is important to recognize, for neurologists and primary care physicians, because it is preventable, treatable, and may herald the onset of a secondary headache disorder. The key to successful management of rebound headache is identifying the source of medication overuse through detailed history and patient diaries. Complete withdrawal from the offending agent is the first step in treatment but can be achieved only with the complete understanding and acceptance by the patient that headaches will get worse before they get better during this process. Numerous preventive therapies are available—the same as those for migraine prophylaxis. Neurologists should become more aware of the prevalence of rebound headache and actively look for it in patients who present with increasing headache frequency. This article provides a discussion of medications that typically cause rebound headache, useful approaches to identifying the offending agents and preparing the patient for with drawal, prescription and nonprescription preventive medications, and transition regimens that can be used during the withdrawal process. (Adv Stud Med. 2003;3(3B):S159-S163)