Medication Overuse Headache (MOH)
Do your headaches get worse the more you take pain medication?
Medication Overuse Headache (MOH), sometimes called rebound headache, occurs when frequent use of headache medications actually makes headaches more frequent and severe. It is one of the most common causes of chronic daily headache and often develops in people with migraine, tension-type headache, or other primary headache disorders.
What Is a Medication Overuse Headache?
MOH happens when the brain becomes sensitized due to regular or excessive use of acute headache medications (such as pain relievers, triptans, or opioids). Instead of providing long-term relief, these medications trigger a cycle of increasing headache frequency, dependence, and reduced response to treatment.
Symptoms of Rebound Headache
Patients often report:
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Headaches occurring 15 or more days per month
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Worsening headaches despite more medication use
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Headaches that improve temporarily after medication, then return
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Morning headaches or daily dull pain with superimposed severe episodes
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Increased sensitivity to light, sound, or exertion
Triggers for Rebound Headache
MOH can result from frequent use of:
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Over-the-counter (OTC) pain relievers (acetaminophen, aspirin, NSAIDs like ibuprofen or naproxen)
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Combination medications with caffeine, butalbital, or codeine
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Triptans (migraine-specific medications)
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Opioids
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Ergotamines
The risk increases with 10–15 or more days of medication use per month depending on the drug type.
Risk factors for Medication-related Headache
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Pre-existing migraine or chronic headache disorder
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High stress and poor sleep
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Frequent use of abortive headache medications
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History of anxiety, depression, or substance dependence
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Female sex (MOH is more common in women
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Using certain pain medications (NSAIDS, Triptans, ergot, barbiturates, etc) for more than 5–15 days a month
How is Rebound Headache diagnosed?
There is no single test for MOH. Diagnosis is made based on:
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Detailed headache history
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Review of medication use patterns
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Ruling out secondary causes with imaging or labs if needed
When should I see a specialist?
If your headaches are persistent even after taking medications, an evaluation by a headache or orofacial pain specialist is recommended.
How is Medication use-related Headache Treated?
At Advanced TMJ Maxillofacial Pain & Sleep Center, we focus on breaking the cycle of overuse and preventing relapse through a comprehensive care plan:
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Medication withdrawal & detoxification – Gradual tapering or sudden discontinuation depending on the drug
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Bridge therapy – Short-term treatments (e.g., nerve blocks, steroids, IV therapy, neuromodulators) to manage withdrawal headaches
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Preventive medications – To reduce long-term headache frequency (such as CGRP inhibitors, beta-blockers, or neuromodulators)
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Behavioral therapy – Stress reduction, sleep optimization, and lifestyle changes
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Physical medicine & adjunct therapies – Posture correction, trigger point therapy, laser therapy, for coexisting TMD or neck-related triggers, neuromodulator devices, ultrasound therapy
How long does it take for MOH to improve after stopping medication?
Most patients notice improvement within 2–8 weeks, though headaches may initially worsen before getting better.
Is it safe to stop medications suddenly?
This depends on the medication. Some (like triptans or NSAIDs) can often be stopped abruptly, while opioids or butalbital may require supervised tapering. Always consult a specialist.
Takeaway:
Medication Overuse Headache is a preventable and reversible condition. If you are finding that pain medications are no longer working and your headaches are becoming more frequent, evaluation by a headache and orofacial pain specialist can help break the cycle and restore lasting relief.
