Case Studies Issue: Analgesic Rebound Headache

By Philip Bain, M.D.
Wilkinson Medical Clinic
Hartland, Wisconsin


RT is a 38-year-old female who visited her primary care physician for evaluation of frequent headaches. She began experiencing headaches at age 20, which she described as intermittent, moderately severe, throbbing headaches that lasted one to two days and were associated with nausea and light sensitivity. The headaches would usually begin one day prior to the onset of menstrual bleeding. She was able to treat them with over-the-counter (OTC) analgesics such as the combination of aspirin, acetaminophen and caffeine.

These headaches began to occur at other times during the month and increased in frequency over the next ten years. While the headaches still responded to the OTC combination, she gradually had to increase her use of the medication. At times, when she had an important family or work obligation, she would take the medication to ‘prevent’ a bad headache from occurring.

By her early thirties, RT occasionally missed work due to headaches. Though she previously was a very sound sleeper, her sleep pattern gradually became more disrupted. She would often wake in the early morning with a bad headache. She also began to notice that it was taking more medication to achieve the same level of pain relief. Her family noticed that she was becoming more irritable and even wondered if she could be depressed. This prompted her to make an appointment with her physician. She told him that she just didn’t want to live like this anymore. Continue Reading

Analgesic Rebound (Medication Overuse Headache)


Analgesic agents are prescription or over-the-counter medications used to control pain including migraine and other types of headaches. When used on a daily or near daily basis, these analgesics can perpetuate the headache process. They may decrease the intensity of the pain for a few hours; however, they appear to feed into the pain system in such a way that chronic headaches may result. The medication overuse headache (MOH) may feel like a dull, tension-type headache or may be a more severe migraine-like headache. Other medication taken to prevent or treat the headaches may not be effective while analgesics are being overused. MOH can occur with most analgesics but are more likely with products containing caffeine or butalbital. Continue Reading