When Medicine Makes Headaches Worse
Experts say any painkiller in your medicine cabinet is capable
of causing rebound headaches if you take it often enough and in a large enough
quantity. Over-the-counter medications that contain aspirin, acetaminophen
(such as Tylenol), and ibuprofen (such as Advil) can all cause rebound
headaches. However, overuse of medications that combine these painkillers with
caffeine, such as Excedrin or Anacin, are even more likely to cause a
"Over-the-counter medications with caffeine are among the
biggest culprits," Gallagher tells WebMD.
The overuse of prescription drugs can also cause rebound
headaches, especially drugs such as Fioricet and Fiorinal -- barbiturate
sedatives mixed with caffeine. Smith says that the overuse of a number of
narcotic painkillers, such as Darvocet, Tylenol with codeine, Vicodin, and
Lortab is also likely to result in rebound headaches.
For many sufferers, it's a combination of prescription and
over-the-counter medications that leads to the problem.
"A lot of people are taking both kinds," says
Gallagher. "They do it because they're desperate. They're in pain and even
if they're already on a prescription, they're easily influenced by commercials
on television for medications designed to treat headaches."
Smith says people often believe that if they can buy something
without a prescription, it can't really be that dangerous.
"I think that patients sometimes look at the disclaimers on
painkiller bottles and assume that the warnings are just perfunctory things
stuck in there by lawyers," says Smith. "However, if people followed
those warnings, they would be at a lower risk of developing medicine overuse
Sometimes, even following the directions on the label isn't
enough. Diamond, Gallagher, and Smith all agree that you should not take any
kind of painkiller for a headache more than two days a week.
However, you may notice that the warning on the bottle of
aspirin, acetaminophen, or ibuprofen says that you can take the medication for
up to ten days. Surely, the warning couldn't be wrong.
"That suggestion is fine for pain other than
headache pain," says Gallagher. "For shoulder or knee pain or something
like that, you can take the medication for a longer time.
"But headaches are totally different," Gallagher
continues. "You cannot use painkillers for headaches more than two days a
week or you're likely to start suffering from rebound pain."
Diamond reports that he regularly sees patients who have
seriously harmed their bodies by overusing painkillers.
When overused, aspirin irritates the digestive tract,
potentially causing bleeding and peptic ulcers; it can also damage the kidneys.
Acetaminophen has its own dangers, and in large enough quantities, it damages
the liver -- especially when combined with alcohol. Most over-the-counter and
prescription painkillers should not be used with alcohol, but that's a warning
frequently ignored, Diamond says.
Sufferers of rebound headaches can gradually get to the point
where they are taking staggering doses of painkillers. "We see patients who
use upwards of 10 to 20 tablets per day," says Smith. "I think my
all-time record holder was a guy who said he took 35 Excedrin a day. I don't
know how he tolerated them."