If you are reading this, you suspect or know that you are in rebound and are considering what it might take to escape rebound headaches.
I’m not going to sugar-coat it. The process is miserable. If you are in rebound, many attempted treatments may not work to get migraine under control. So, educate yourself about what to expect and how to optimize the process so you can get prepared and find your motivation. You are not alone in this. Many of us have been in a terrible rebound cycle at least once. The good news is that there is a good chance you will go back to your baseline, episodic frequency once you are ‘on the other side of rebound.’ And, if your frequency of symptoms still has you classified as ‘chronic’, your doctors can help you get better. We’ve come up with these steps to help you escape rebound headaches.
Since the original writing of this article in 2018 many new medications have come out that can and do make getting through rebound much easier. With that said, many people are still or newly in rebound, so the info in this article is still valid, but thank goodness for better tools to help.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Step 1: Find Your Motivation
Find your motivation. What would be possible if you didn’t have chronic or daily pain? How much better would things be? What would be possible if you did not need to take so many medications?
Step 2: Consult Your Physician
Find a neurologist that you trust and has a lot of migraine experience. First, they will help figure out a proper diagnosis. They will find a solution for getting your condition under better control after you have detoxed from the rebound meds. Seek a neurologist who will work in partnership with you or consult with a certified headache specialist. Check HERE for a current list. We recommend finding a good doctor to help you through this process. If you do not have access to a doctor with expertise in migraine or the wait is too long to see her/him, you still have a great option with Cove. I used this simple, fast, effective online service when I moved to an area without migraine expertise. I was very impressed with the Cove doctor’s ability to help me so quickly.
A neurologist or headache specialist will evaluate you and determine if the rebound meds should be tapered or abruptly stopped. They sometimes use a ‘bridge therapy’. This is a medication to help ‘bridge’ the most unpleasant time between rebound and when the desire for acute meds may be less strong. Oral steroids can help break the pain cycle. In some cases, the recommendation may be for use of an intravenous DHE ‘cocktail’. The IV therapy may be done as out-patient or as in-patient. Your doctor looks at your situation and makes recommendations based on what they think is most effective. Approaches will vary. Some doctors don’t recommend a bridge therapy. They will just advise reducing the number of days of treatment and pushing through the detox process.
Ask your doctor what you can take for relief during and after the process of detoxing from the rebound meds. There are classes of medications available by prescription that may help including Zofran, Compazine and Phenergan. Additionally, Benadryl may also prove helpful. If nausea and vomiting are a typical problem for you, specifically ask for suppositories or injectables. A doctor with lots of experience with migraine may offer these options. Ask about them if they are not offered. Many doctors believe that patients shouldn’t take medications associated with rebound for months after getting through the detox phase. Every individual is different. Some may be able to stay out of rebound after a few months yet others may only need just a few weeks. Make a plan for how to treat migraine attacks after the wash-out period with your doctor.
Your doctor may also implement or adjust your preventive medication strategy. Keep in mind that there are several treatments besides daily medications that may help you including injections and Neuromodulation devices. Additionally, the newer anti-CGRP are very helpful for many people.
There is a big and important study being conducted right now to help understand the best treatment for chronic migraine complicated by rebound. HERE is a 2-minute video from one of the main researchers. Your doctor may have some good options for you for meds besides a steroid or DHE.
Step 3: Plan Your Start Date
There is never a convenient time to feel awful, but give some thought as to when it would make the most sense. For instance, consider planning it for a time when you would be able to take time off from work. Or, plan it for a time that friends or family would be able to lend a hand in taking care of your home, kids, pets, etc. Hope for the best but plan for the worst so you can get through the process. It might not be bad at all, especially if you have a helpful doctor and some support.
Step 4: Optimize Your Wellness
Optimize your migraine wellness by understanding common triggers, avoiding the ones you have identified, minimizing controllable triggers (ie. dehydration, inconsistent sleep, food triggers, etc.). If you haven’t already started the evidence-based supplements like magnesium, riboflavin and coenzyme Q10, do your research and consider starting. Whether you enjoy meditating or not, now is the time to begin this practice or increase it. Studies show that our brains respond favorably to meditation. HERE is an example of one study that shows that ten minutes of meditation per day can make a difference. The Calm app is free and has many options to help soothe your cranky neurons. If you find that meditation isn’t something you can do while in significant pain, try something that is ‘meditative’ like adult coloring or going for a gentle walk.
Step 5: Set-up Your Environment
Set-up your environment to support feeling the best you can during this lousy detox phase. Read about ginger and have it on-hand. Have plenty of liquids in your home to keep you well-hydrated. Keep ice packs and heating pads nearby. If you like essential oils, have those nearby as well. Peppermint and lavender tend to be favorites for soothing migraine symptoms. Migarine Stick or MigraSoothe and topical lotions/balms like IcyHot and Biofreeze also may be helpful. The headache hat is an easy way to have a wearable icepack. Epsom salt baths can be very soothing as well as magnesium foot soaks. Think through a good self-care plan that will help you stay motivated. Engage a team of supporters whether it’s friends and family or social media. Mindset is very important so you may want to read inspirational stories and watch uplifting shows. You can do this but you might need some love, support, encouragement and pleasant distraction.
Step 6: Make A Plan For The Future
Have a plan to keep you out of the rebound trap. Migraine is a neurological disease that occurs on a spectrum. Depending on where you are on this spectrum, you may need one or more medications and therapy. It’s also possible that you can find a good acute medication that reduces your frequency and intensity of migraine attacks without getting you back into rebound. Your doctor can help you with a plan that keeps you out of rebound and in better control of migraine flares. There is also a lot you can do with lifestyle and stress management to kick migraine to the curb and feel well again. In our next blog, we address frequently asked questions about rebound and how to avoid getting into future rebound cycles.
Important: The above information is based on reviews of medical literature, professional and personal experience. It is for educational purposes and is not a substitute for medical advice. Please see your doctor before making any changes to your care.