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.
What prescribed meds contribute to rebound?
Simple analgesics – Prescribed NSAIDs (i.e. indomethacin, naproxen) Combination pain relievers (i.e. Fioricet)
Triptans (i.e. sumatriptan, rizatriptan) and ergotamine medications (i.e. DHE)
Opioids (i.e. tramadol, hydrocodone, codeine, oxycodone)
Fioricet (combination of butalbital, acetaminophen and caffeine) and Fiorinal (combination of butalbital, aspirin and caffeine)
What over-the-counter meds cause rebound?
Simple analgesics – NSAIDs (i.e ibuprofen, naproxen) acetaminophen, aspirin
Combination pain relievers (i.e. Excedrin Migraine, Excedrin, Goody’s Headache Powder)
Does Aleve cause rebound? How about Tylenol?
Yes, for both medications. They are simple analgesics.
Why would my doctor prescribe meds that would put me in rebound?
Doctors want to help their patients feel better. Many are not aware of the risk of rebound, especially if they are general practitioners. Some doctors prescribe these meds as they are not able to provide the support needed to motivate their patient to successfully get through the detox process and stay out of rebound again.
Some doctors have limited choices for effective medications to prescribe to help.
There is a small group of neurologists who question the concept of rebound and allow a small percentage of their patients to take frequent rebound meds as a last-resort. An important study is being done to determine the safest and most effective way to treat chronic migraine combined with the complication of rebound and this short video explains it HERE.
There is general agreement that effective treatments can be thwarted by rebound, so getting out of rebound should be a priority.
Why does my head hurt when the triptan wears off?
The pain is thought to be a withdrawal reaction. It is paradoxical as the medication initially helps. When used too often it worsens the condition and gives the person head pain which in turn can lead to another migraine attack.
What about caffeine and rebound? I drink coffee and caffeine is in some of the meds I take.
Yes, addressing caffeine is important as it can cause rebound. Our blog HERE has lots of info on caffeine.
If I take 5 triptans per month, can I be in rebound?
Probably not. A person is at risk when taking more than 10 triptans per month regularly for more than 3 months. If you also take NSAIDS or opioids in addition to the 5 triptans consistently for 3 months or more you may be at risk.
Why isn’t diet working for me?
The topic of this FAQ blog is rebound. Not much will work while in rebound. So, dietary modifications will not bring relief if you are in rebound. If you are not in rebound and diet isn’t working there could be a number of reasons why. This blog addresses when the migraine diet doesn’t work. Finding the right diet can be helpful.
How long do you have to be on NSAIDs and triptans to be at risk for rebound?
NSAIDs and simple analgesics, 15 days per month on a regular basis for at least 3 months. Triptans, 10 days per month on a regular basis for at least 3 months. For combination pain-relievers, 10 days per month on a regular basis for at least 3 months. When using a combination of different meds that put you at risk for rebound, the guideline is 10 treatment days per month in a regular basis for 3 months. Fioricet may contribute to the rebound cycle in as few as 4 days according the the AMF. The American Migraine Foundation has more details about rebound.
How do I know I’m in rebound?
Refer to this article about risk of rebound. Your frequency and the type of medications put you at risk or not. After you assess your risk, your history and symptoms will help you figure it out.
How long will it take to get out of rebound?
It’s hard to say as everyone is different and the degree of the rebound condition varies. Some experts say 1-2 weeks and some say up to 6 months. In our personal and professional experience, the worst part is usually over within a week. The improvement after the initial 1-2 weeks will vary but is usually measured in months, not weeks. It is not unusual to continue to have some lower-level pain for months after stopping the rebound cycle.
Can I take any NSAIDs while getting out of rebound?
Unfortunately, there is conflicting data on this. Some people can get through rebound with some medications but others cannot. We think it’s better to assume taking any meds associated with rebound may interfere with the detox process. There is no data suggesting that taking 1 dose will derail the entire detox effort, but there is no data saying that it won’t. Do your best to find the support you need to get though it without rebound meds. Only you will know if taking a rebound med is necessary for what you may be facing.
There are several options to help you with attacks that are not associated with rebound.
Is it safe to take triptans every day? If it was developed for migraine, why can’t I take a triptan daily?
Triptans have improved the lives of many people with migraine. They are potent drugs that alter brain chemistry. Many people experience significant side effects from triptans. There is good evidence that shows that frequent use of triptan medications can make people with migraine have worsening symptoms. It may interfere with otherwise effective preventive medicines and therapies. Aside from this group of medications for migraine, it is not uncommon for medications to be limited in frequency for both safety and efficacy.
Can I take 10 triptans a month and 10 over-the-counter meds per month without being at risk for rebound?
No. The guideline, when including triptans is a total of 10 treatment days per month.
Does eating too much gluten cause rebound?
No. Rebound is another word for medication-overuse headache. For some people, gluten may be a food trigger for migraine. For others, it may not be a direct trigger, but removing gluten from the diet might be helpful overall.
Is there any other way to stop rebound other than stopping the pain-relief meds?
Yes and no. There are prescribed meds that can help break the pain cycle like steroids and ‘DHE cocktails’ used as ‘bridge therapies’. Also, there may be some preventive meds that will work on the mechanism of migraine to help (i.e. botox and some of the common preventives). It’s important to work with an experienced doctor to help figure out what they think is the best plan for you. The goal will be getting the migraine symptoms in better control so that the need for pain-relief meds is infrequent and not contributing to rebound.
However, for a significant portion of people, being in rebound will not allow the preventive treatments to work. A study is being done to look at this issue and HERE is a short video about it. Most commonly, we see recommendations to stop the use of the meds causing rebound with the help of steroids. So, you might be able to work with your doctor to get out of rebound using other medications, but usually you have to go through detoxing from the meds rather than ‘going around’ detoxing.
What can I take to help while detoxing from rebound?
In terms of prescribed medications to break the cycle, your doctor may have some good options for you. We commonly see oral steroids prescribed. IV ‘DHE cocktails’ are also helpful when steroids do not help. Your doc may also wish to try a different preventive medication at the same time.
Other prescribed meds that are for the acute treatment of migraine symptoms that do not contribute to rebound tend to be in the group of meds usually used for nausea and vomiting (i.e. Zofran, Compazine, Reglan, Phenergan). Yes, they also work for head pain and may help you minimize your symptoms.
Muscle relaxants are another option.
New anti-CGRP medications are also effective acute treatments for migraine attacks and not associated with rebound risk.
Over-the-counter medications that help many people and are not associated with rebound are diphenhydramine (Benadryl) and meclizine.
For those living in states with favorable medical marijuana laws, marijuana may be a helpful option. CBD oil is available across the US and can be helpful when taken daily.
There is no general consensus on the best way to help people through this process and results from studies on this topic of “detox” vary. Hopefully you have a knowledgeable healthcare provider that will help you get through the detox phases as well as the wash-out period.
Do botox injections cause rebound?
No. Botox wears off over time but is not associated with rebound. Botox may be very helpful as a preventive.
Does ginger cause rebound?
There are no studies suggesting that ginger causes rebound. We advocate its use as it is effective, available, inexpensive and not associated with the side-effects that many prescribed and OTC meds have. We encourage people to do their own research and decide what is best for their situation.
Does feverfew cause rebound?
There are no studies suggesting that feverfew causes rebound. We advocate its use as it is effective, available, inexpensive and not associated with the side-effects that many prescribed and OTC meds have. We encourage people to do their own research and decide what is best for their situation.
How long do I need to remain off pain meds?
There is no well-researched answer to this question. Since some experts suggest that the detox process takes a few days to a week and that the “washout” period may take months. We suggest the time away from rebound medications be measured in months rather than weeks.
This is a reason why you may need a good doctor to help you with prescribed meds that are not associated with rebound. The good news is that the medication that caused your rebound may work great for you again in the future. But, use it with caution to avoid rebound again.
Will cannabis cause rebound?
There are no studies suggesting that medical marijuana causes rebound. Studying medical marijuana is very challenging given federal laws. We have seen it used effectively for migraine symptoms without the side-effects that many prescribed and OTC meds have. We encourage people to do their own research and decide what plan of action to take.
Does Sudafed cause rebound?
Sudafed and other decongestants are not on the list of meds included in the medical definition of rebound. However, some neurologists and headache specialists caution against using decongestants regularly. This does not mean Sudafed and similar meds should not be used to treat a cold. The caution is for regular use.
What are the worst medications for rebound?
Based on the research literature, the prescribed medications that put people at the highest risk are opioids and combination meds like Fioricet. Here is a quick summary about a study looking at opioids and migraine. In addition to those meds causing rebound, they also have other negative effects. Most skilled neurologists and headache specialists will not use them or will only use them in a very limited way. Combination analgesics that are available over-the-counter like Excedrin Migraine are also on the list of “the worst” for rebound.
I looked at the criteria for rebound and I do not have rebound, but I am afraid of getting to that point. What can I do?
First, look at what was prescribed for you and make sure you are following the advice. For example, if you were prescribed 100mg of sumatriptan but cut the pills in half, stop cutting the pills in half and take the medication as advised. Ask your doctor, about combining a triptan with Aleve and/or Benadryl to be more helpful. Sometimes migraine needs a bigger punch in the nose to knock it out and keep it from coming back. A full dose or your triptan or the triptan enhanced by an NSAID and/or Benadryl may give you lasting relief.
Next, prioritize a lifestyle that supports migraine wellness and minimizes controllable triggers including stress. If you need help figuring out what to do to help yourself, consider hiring a wellness coach for a short time.
Can I have daily or frequent symptoms, take a lot of acute medications and not be in rebound?
Yes. The medications put you AT RISK for rebound. Some people have frequent and chronic symptoms unrelated to medications associated with rebound. The only way to know if use of migraine medication is making matters worse is by working with a physician with great expertise in helping people manage frequent and chronic migraine. You must be 100% upfront with your doctor about the amount of OTC and prescribed meds.
The idea of stopping these meds is overwhelming! I need to function!
Yes, this is why it’s so important to find an expert in managing migraine so you can get the help you need so you need less acute medication. It can be done. There are many existing medications, new medications and new treatments for migraine that may help you get through the detox process if you are in rebound. If your migraine frequency is not well controlled a good headache specialist can help you find more effective tools so you feel less need for acute medications.
This article on getting through rebound gives more detailed info to support you when and if you decide to get through it.