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When Medicine Makes Headaches Worse

The Culprits

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 problem.

"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."

Deceptive Warnings

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 headaches."

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."

Rebounding Risks

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."

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