Poor migraine control leads to chronic daily headache

Many patients manage their infrequent migraine headaches with triptan medications, such as sumatriptan.

We call these “abortive” medications – you take them as needed whenever you have a headache to make it go away.

These medications set off an “explosion” of chemicals inside the brain, “extinguishing” the migraine just like an explosion of dynamite can put out an uncontrolled oil rig fire:

However, sometimes, that “chemical explosion” doesn’t put the fire out completely, and it comes right back.

We call this “rebound” headache, and we have already blogged about how taking too much abortive medication (including over the counter medications like Excedrin Migraine) for migraines can lead to  headache all the time, chronic daily headache, because of analgesic rebound.

Data from a new study has recently confirmed this:  The large American Migraine Prevalence and Prevention (AMPP) study showed that patients with very poor headache control were 4 times more likely to progress into chronic migraine during the following year than those with better control.

Clearly, poor headache control leads to more and more headaches, presumably because of analgesic rebound.

The solution?  Obtaining more sustained migraine control by starting a daily preventative medication for migraine like topiramate, valproic acid or botulinum toxin.

If your headaches are getting more frequent or out of control, seek the help of a board certified neurologist sooner rather than later!

Headache pills, are they hurting more than they are helping?

Headache is a common problem.  Almost 20% of men and 40% of women in the USA experience recurrent headaches.  Headache is the most common reason for a neurology office visit, the third most common cause of missed work, and the seventh most common reason for a primary health care visit.

Headaches are  broadly divided into two categories:  Primary headaches, such as migraine and tension headache, are most common.  Secondary headaches are symptoms caused by other diseases, some of them serious like a ruptured aneurysm, brain tumors, acute glaucoma or vasculitis.

Most headache sufferers are using abortive medication as needed every time they experience the symptom:

Some are taking prescription medications such as triptans or drugs containing butalbital (such as Fioricet (c) or Esgic (c)).

Many more are using over the counter medications such as acetaminophen, ibuprofen or combination pills such as aspirin/acetaminophen/caffeine (Excedrin (c)).

This strategy can work, particularly for infrequent headaches, such as once or twice a week.

However, more frequent use of these medications, particularly short-acting triptans (such as sumatriptan) and drugs containing caffeine and butalbital, can lead to rebound headache, which leads to more medication use and more headaches, culminating in chronic daily headache from transformed migraine.

The only way to deal with this is to temporarily stop the offending abortive drug and  start a daily preventative drug.  This will lead to short period of drug withdrawal, when the headaches may get worse before they ultimately get better.  This can sometimes necessitate short term headache infusions with dihydroergotamine (DHE) or a course of steroids.

Any headache sufferer who finds themselves in this situation should consult with a neurologist or other headache specialist.