Americans spend some $3 billion a year on over-the-counter headache remedies. But many experts believe some headaches — so-called rebound headaches — are actually caused by the very same medicines people are taking to stop them.
Dr. Fred Sheftell, one of the world's most-respected headache doctors, is upset that the labels on over-the-counter headache remedies offer absolutely no warning about rebound. "There's nothing that I know of where any of these products say anything about the genesis of rebound headaches and chronic daily headache. … I'd like to see that."
A Vicious Cycle
Here's how experts think rebound starts. Normally, when you take a pain reliever for an occasional headache, the medicine turns off pain receptors in the brain. But in a person prone to headaches — especially migraine headaches — pain relievers taken more than two to three days a week on a regular basis can make the pain receptors more sensitive than usual.
Consequently, as soon as the medicine wears off, these hyper-sensitive receptors turn on to produce a new headache. That leads the headache sufferer to take more medicine, which, in turn, leads to more headaches — a truly vicious cycle. Before long, most rebound patients are taking headache medicine every single day.
This vicious cycle nearly killed Eric Peterson, a 26-year-old veterinary student. But what will shock you is how little medicine it took to get him in trouble. Peterson's problems started in high school with migraine headaches that hit him a couple of times a week.
"I think I started with an ibuprofen type. I wasn't finding a tremendous amount of relief with that. And tried Excedrin — found that controlled things nicely for me," Peterson said.
Daily Habit Can Trigger Serious Health Problems
Initially, Peterson was able to manage his headaches by taking two Excedrin just two to three times a week. But that was enough to lead to rebound headaches. Soon, Eric was taking the pain relievers every day, which was very bad for both his head ... and his stomach.
Peterson's health problems became painfully clear last summer at a Chicago Cubs game. "We were walking up the stands to find our seats and I became very dizzy and light-headed and nearly passed out," he said.
Years of taking Excedrin had eaten away at Peterson's stomach lining. He was sitting in the stands slowly bleeding to death. Just four hours later Eric wound up in a hospital emergency room. Doctors were able to save his life, but they told him he could no longer take over-the-counter pain killers.
This was frightening news for Peterson, who had become so reliant on the pain relievers, he was more concerned about he was going to manage his headaches than he was about the damage to his stomach. "I didn't know how I was going to cope from day to day without having to be able to take that medication," he said.
Stop the Medicine, Stop the Pain?
Duane Soderquist, 25 years ago, was in a situation very similar to Peterson's. Soderquist said, "I think I had seven free headache days in 10 years."
It was Soderquist's case that caught the attention of Dr. Joel Saper, a neurologist and founder of the Michigan Head-Pain Neurological Institute in Ann Arbor. A pioneer in the treatment of rebound headaches, Saper said it was Soderquist who first opened his eyes to the fact that over-the-counter medications could imprison a brain in rebound headaches.
Soderquist had seen 20 doctors for his excruciating daily headaches. At that time, no one realized that his headaches were a result of the hyper-sensitive pain receptors in his brain turned on by the handfuls of over-the-counter medication he was taking every single day. Soderquist said he was taking about 50 tablets a day.
Saper hospitalized Soderquist, taking him off the medication. "I thought I was gonna die for three days," Soderquist said. But then an amazing thing happened. Once the medication had cleared from Soderquist's system, his headaches stopped — for the first time in 10 years. Saper said, "That's when I learned the power and the potency of the rebound effect. And the need to take people off those medicines."
Today, Soderquist is virtually headache-free and enormously grateful to Dr. Saper. "The day I left and went home after not having a headache — there at the hospital, the last day — it was just like somebody took a house off my back," Soderquist said.
Nearly 90 percent of the patients at Dr. Saper's headache clinic are diagnosed with rebound headaches. And each one takes the same first step: Stop the medicine.
Eric Peterson was actually able to detox at home. But he admits it was brutal. "For probably about three days I just had intolerable headaches. … It was probably the most miserable three days of my life," he said.
But the payoff was worth it — Eric is finally free from daily rebound headaches. And he's managing his occasional migraines with preventive medications and newer treatments like biofeedback.
Can You Get Hooked?
So, do these cases mean you could get hooked on the over-the-counter pain medicines you're taking? It's important to remember that if you're taking these medicines for other problems, like arthritis, it's usually OK. Rebound headache can be triggered by the overuse of a wide variety of over-the-counter and prescription medications.
But if you're starting to take medicines more frequently for headaches — be careful. Also remember that migraines are the kind of headache most likely to lead to rebound.
Dr. Saper said it's most important that frequent headache sufferers consult a physician. "If you're using this medication more than two or three days per week on a regular basis," Dr. Saper said, "talk to your doctor about the possibility of rebound headache."