Rebound headaches

[KatherineM_PBC]

We are always told not to over medicate/take pain killers for too many days a month or we will get rebound headaches. My mum has bad arthritis and takes ibuprofen 3 times every day (under the care of her GP). How is it that painkillers can cause rebound headaches, yet with other conditions it doesn't make the pain worse?

[deb25426]

I an only say from my own experience. Before Christmas I had a nasty flu like virus, it left me with sinusitis! I was taking paracetamol when I needed to (within the doseage guidelines), into the new year it left me with ear ache everyday for a couple of weeks...and a couple of times migraine(which I do have now and again)...I went to doctors as I was worried about the paracetamol (and I was taking ibuprofen at least once a day) I was taking over the 3- 4 weeks and I mentioned I thought my headaches were bounce back and he told me that paracetamol the way I was taking it wouldn’t cause bounce back headaches.. I do have to be careful how much ibuprofen I take as it can cause me tummy issues....

[babs1234]

I really don’t know but was told by my headache specialist not to take any pain killers. Sorry but he isn’t the one lying in bed night after night in in pain. I did try it and suffered for a week and it didn’t make any difference to my headaches

[KatherineM_PBC in reply to babs1234]

Don't take ANY painkillers!! He's obviously never had a migraine😡

[Cat00 in reply to babs1234]

A week off painkillers is nowhere near enough to stop you getting rebound headaches. 3 months is the normal time off painkillers. It may be harsh but it's the reality, it has nothing to do with a doctors experience of pain, it's how long the brain takes to stop being over excited. I take no more than 6 triptans a month I have migraines over 50% of the time. I couldn't take painkillers for my broken ankle or 2 difficult pregnancies. It's just the way it is.

[Cat00]

I asked my neurologist last time I saw her and she says it's because with chronic migraineurs pain pathways are too excitable and can be triggered by lost lots of things, no sleep etc, and that when triptans/pain killers go down these pathways it's essentially another type of activation of the path pathways.

People with inflammation like with arthritis don't have these type of structures in brain presumably they have different ones?

Migraineurs, or at least chronic migraineurs have almost by definition an illness of the pain pathways in the brain.

This is my understanding at least, I presume it's a whole lot more complicated than that in reality!

[Katya3]

I come from a family of migraineurs, my mum had them and so did her mum and various aunts and uncles. This was before pain killers (we are talking in the 1800s) and they evolved a family way of coping which was at first sign of migraine go to bed in a darkened room, drink plenty of boiled water and eat nothing except cream crackers, let the body completely relax and in our family at least we sleep. This meant that each migraine was 48 hours lost BUT on this regime, which I also followed till triptans were discovered, they had far fewer migraines than I have now if I take triptans.

This was before the 24/7 culture and they were a large family in a society where women did not go to work, so other family members covered for the sick person and you could rest without worrying. I wonder if the triptans keep us going but at the price of more migraines and if society accepted that we simply need to rest then we would have fewer migraines and be more healthy generally, I take triptans as little as possible and try to just stay in bed when I have a migraine, I am in my 60s now and still work part time and take regular exercise when many of my "healthy" contemporaries are too worn out to do either of these things.

I can understand that if you are suffering from weekly or more frequent migraines this post could make you want to scream with frustration, but for those of us whose migraines are on the once or twice a month level I wonder if rest is an unsung method of recovery and migraine control.

[KatherineM_PBC]

My dad had episodic Migraine, I remember as a small child 40+ years ago, he would do the same as your family, go to bed in a dark room with a cold flannel on his head. Im thinking he may have taken paracetamol but there was probably no better pain killer at that time? When dad retired he didn’t get migraine so we assumed his were stress related due to his job.

I’m a busy mum who runs a small business. I cannot go sick as there is no one to cover, I’ve often worked a shift when all I want to do is lie in bed but it’s my livelihood and I don’t want to give it up. I don’t take triptans as they make me feel depressed but I reach for the pain killers immediately, I can sometimes quash an attack with 3 soluble aspirin or will take naproxen with food. I worry about using pain killers too often when I’m in a bad flare but I couldn’t imagine trying without? I guess for some of us it’s a viscous circle? Before all these drugs came along people really had to suffer, migraine, labour etc without pain relief....can you imagine 😫

[Katya3 in reply to KatherineM_PBC]

I do feel for your dad. I hope he had a reasonably sympathetic employer. My mum was lucky in that she was able to work from home as an outdoor closer in the shoe industry and work at a pace that suited her. Like many migraine sufferers she was very conscientious and good at detail so she did a lot of fine quality work where timetable was less important than quality. Once she got out of the factory her health improved a lot.

I agree with you about prompt action with aspirin and in my case sweet tea. Small regular meals also help me to reduce the frequency of migraine attacks. Having to keep going with a migraine is hell. Worst for me was doing presentations for clients in far off places and then having to lie on the boardroom floor afterwards to get well enough to drive home throwing up in convenient laybys en route. That was definitely a 3 days in bed job when I got home.

I was also a busy mum running a small business. Kids are grown up now but I have caring responsibilities for elderly mother. I have only ever managed to work part time which kept the business very small. I am lucky in that I do market research which is mostly desk based and I can go to bed during the week with a migraine and catch up at the weekend when I feel better. I fell into a routine of always working with a business partner or job share and making sure we did everything together so that if I collapsed just before an important presentation my partner could go ahead without me, It is not a cost effective way of working, so my take home pay was less than that of my contemporaries, but I made some very good friends and as we reach retirement age this way of working means we have been able to go on working for much longer than friends who did a full time job and had to stop.

[KatherineM_PBC in reply to Katya3]

Thankyou for the reply Katya, I cannot imagine how hard it would have been for you to present to a room full of people, often my brain turns to mush, but surprisingly when I'm speaking to clients I hear the words coming out parrot fashion!

I am 2.5 years into migraine and have seen all sorts of specialists, currently on Amitriptyline but it doesn't prevent all attacks, so I'm still fighting, and currently waiting on an appt with a top Gynae consultant who's interest is in women health, migraine and hormones, to see if she has any answers to my sudden onset migraine aged 49.

I have some part time staff but have resisted getting more so I don't have to work at all, I think if I didn't push myself out of the house some days I would become very lazy, in body and mind. However, the thought of going into work makes me feel quite anxious and that probably doesn't help the headaches? I have a friend who is a mortgage advisor, he is looking to take on new advisors who work from home, so this might work for me as I have a banking background, and I could staff my business full time? It must be great to have a very understanding business partner who can take over when you're having bad days.

I too have an elderly mum and do all her shopping and take her to various appts, Doc, dentist, physio, never ending, so I understand how this weighs on you. She is determined to remain independent, despite the fact she can no longer look after her house and garden. In my current condition I refuse to take on these chores with mine, she understands that as she has been a huge emotional support to me, and allows me to find gardeners and the like to help her. She has an alarm she wears around her neck, she set it off by mistake the other day giving me a fright! In a way I would rather she just agree to go into a private care home, even if it means spending the value of her home on her care, as I feel I'm not reliable enough for too much responsibility.

I wonder if this is just a phase of illness that will pass, I must hope I find my answers soon, or at least as I get into retirement age that the migraine ease off so I may be able to enjoy some me time. Best wishes to you xx

[Katya3 in reply to KatherineM_PBC]

Sounds like you have an awful lot on your plate - and migraine starting when you already have a shedload of responsibilities is not an easy thing to deal with. I am sure you already know that you can't do everything for everyone and that you need to pace yourself within your limitations, also easier said than done. Hopefully if your dad had migraine your mum will understand where you are coming from and be prepared to accept help. Are you registered with your doctor as a carer? You get free flu jabs and they can put you in touch with local carers support groups who can help you set realistic expectations for what you can do for your mum.

You can only do as much work as the illness will permit, but that may well be enough to enable you to run a business and let others do a lot of the work. If you look around you could find that there are other people whose circumstances will only permit them to work part time and who would welcome you as the understanding employer/business partner they are looking for. Over the 30 years I have run a small business with migraine I have worked with several MSc and PhD students, a retired head mistress let go before she wanted to stop work, a former head of HR at the local John Lewis, also let go before retirement age, several mums with preschool children who did not want a regular work commitment, someone with IBS who could no longer cope with driving half way round the M25 twice a day and someone who had a heart attack at 50 and needed a less pressured life - not to mention 2 job shares. Office Angels and other employment agencies provided me with most of these people. Part time flexible working is in short supply and you may well find there are more capable people out there who would like to work with you than you currently think possible.

Good luck with whatever you decide to do - and with your Gynae consultant. Best wishes to you too. X

[Quito]

Hi Katherine - I've also been told the same thing that Cat00 mentioned - about pain pathways in the brain being different in migraineurs - so others on long-term pain relief won't experience the same thing that we do.

I've also quizzed my neurologist about which painkillers cause rebound and the consensus is that it's: caffeine, paracetamol, codeine and triptans. So, we can take NSAIDs more frequently (woohoo! but beware the stomach problems... only take them with food etc and a huge glass of water).

My doc recommended always taking 600-800mg ibuprofen at a time (up to 3 x per day if terrible) and otherwise, 3 x soluble aspirin with a Coke! So, I mix up my drugs across the month, making sure I have no more than 8 days of the first set (paracetamol, codeine, triptans) and then use NSAID's on other days.

[KatherineM_PBC in reply to Quito]

OK I'm slightly relieved that the Neuro said NSAIDs might be less likely to cause rebound, when I have to take them for a day or 2 at a time I take Lansoprazole for my stomach too, although the Doc told me not to take them every day 😏

I know they are making advances with migraine drugs with the new CGRP injections, but surely medical science can come up with a bl**dy good pain killer that doesn't give you a stomach ache! There is an ibuprofen tablet advertised on TV called Flarin, it claims to be made up with lipids so it doesn't damage the stomach. I asked my Pharmacist if they have had any positive feedback as the box says it will help migraine etc, he said they would probably sell more if they didn't cost £9.95 for 30 tablets!!!!!

[babs1234 in reply to Quito]

So weird. Anadin extra is the only thing that touches my headaches and it’s got caffeine in ?

[KatherineM_PBC in reply to babs1234]

They say to take painkillers with regular Coco-cola, that's full of caffeine, but then tell us to avoid caffeine during the day. It's a minefield!

[Chleo11 in reply to KatherineM_PBC]

Hi Katherine. Just came across your post and thought I might let you know. I have tried Flarin (yes, expensive, I know). I do reckon that it is quite a good product. I suffer a lot with my stomach when I take any medic (especially ibuprofen: ouch!). These tablets had absolutely NO effect whatsoever on my stomach. I could hardly believe it. Even paracetamol hurts my stomach normally. I did find as well that the tablets end up being stronger than normal ibuprofen. The first time I took them they started to work within 10 minutes and got rid of my headache totally (it wasn't a migraine, mind you). I only have a bit of an issue but it may just be me being paranoid: they say that the shell contains some sorbitol (for manufacturing purpose, I suppose). As I have some suspicions that sorbitol may trigger my migraines, I have sent them an email asking how much there is of it and if it may cause an issue for people sensitive to this. They never responded. As I have daily headaches/migraines, I didn't know if the next headache may have been caused by this, while getting rid of the first one, ironically.

In relation to the previous messages, as far as I know, NSAIDs are causing rebound headaches as much as anything else, as far as I was told. I suppose that the best way to know if you are having an overuse of a specific medic, is when your usual tablets, at the same dosage, don't help you anymore and you have to take more. Best wishes.