Treating Chronic Daily Headache, Fibromyalgia and More
Q: I have had chronic daily headaches and migraines with aura for years. I also have fibromyalgia, TMJ (temporomandibular joint syndrome) disorder and irritable bowel syndrome (IBS). All of these involve chronic pain. I take Relpax® for the migraines, which helps a lot with the aura and works okay for the headache. I also take Cymbalta® for depression, but haven't noticed any pain relief from it. The only other medication I seem to tolerate is Advil®.
Since I have a headache “24-7”, with no beginning or ending, I never really know what causes it. How many pain relievers (like Advil) do you have to take to get a rebound headache? I never take more than two a day, but I wonder if taking them for several days makes my headache worse. I want to do anything I can to prevent an already difficult situation from getting worse.
A: Chronic daily headaches are commonly associated with fibromyalgia, TMJ, IBS and other chronic pain disorders. The treatment for all those disorders is even similar. However, there is always a risk that overuse of pain medications will cause rebound headache, tolerance (a need for higher and more frequent dosing) and/or dependency.
Opioid-type analgesics, caffeinated products, barbiturates, triptans and ergots are known to be the main cause of rebound headaches. There is a debate as to whether nonsteroidal anti-inflammatory medications (such as Advil and Aleve®) may also be responsible. I think that you should seek help from a headache clinic, where these issues can be addressed.
George Urban, MD, Diamond Headache Clinic, Chicago, IL