Medication Overuse Headache
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Medication overuse headache (AKA rebound headache) usually occurs in patients with a past medical history of severe headache, for which they have frequently/ excessively used analgesics.

Clinical Features

  • Chronic headache occurring >15 days per month.
  • Develops or worsens with frequent use of any drug treatment for pain in people with tension headache/ migraine.
  • Resolves following withdrawal of symptomatic treatment.


Aetiology and Pathophysiology

  • Affects anyone age 12+ but more common in adults.
  • Now considered the third most prevalent type of headache – prevalence of 2%.
  • The condition is a common reason for episodic headache becoming chronic daily headache; frequently occur in patients with an underlying headache disorder such as migraine, which changes from an episodic to a chronic disorder following excessive use of headache relief medications.
  • Culprits are mixed analgesics, especially those containing paracetamol, codeine, opiates, ergotamine and triptans.
  • It is thought that in individuals predisposed to migraine or tension headaches, frequent symptomatic treatment of any kind of pain (including headache disorders) leads to the progressive down-regulation of receptors inhibiting pain, thereby increasing sensitivity to pain and thus the tendency to develop headache.



  • Analgesia must be withdrawn – aspirin or naproxen may mollify the rebound headache.
  • Preventative once other drugs withdrawn, e.g. tricyclics, valproate, gabapentin).
  • Advise against over use of analgesia – no more than 6 days per month.
  • A long-acting analgesic/ anti-inflammatory such as naproxen can be used to ease headache during the withdrawal period.
  • An anti-emetic may also be required to aid the withdrawal process.


  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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