FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[READER PROBABLY SUFFERING FROM "REBOUND HEADACHE" ]

Question: I take Tylenol or aspirin at least once a day for my headaches. I don't have severe pain with the headache, just an annoying ache. These medicines usually work for me. Is it OK to continue to take these pain relievers every day?

Answer: Headache is a common malady that occasionally bothers nearly everyone. When you have a headache, it is only a symptom of one of many possible underlying conditions - the most common of which is the so-called "tension headache." This label, however, doesn't accurately describe the ill-defined cause of the pain. Migraine, which afflicts 10 to 20 percent of the population, is the next most common cause of headache. Sinus infections and many uncommon conditions occasionally cause headaches.

Any headache that is severe, lasts more that a day, or keeps reccurring - like yours does - should be brought to your physician's attention. You should do this to get relief from the pain as well as to be sure that the underlying cause of the headache isn't a serious condition.

A frequently overlooked cause of daily headache is a condition call "rebound headache." Taking as little as 1000 milligrams of aspirin or acetaminophen (generic name of the drug in Tylenol) can actually cause a headache as the drug wears off. This rebound phenomenon is not just limited to aspirin and acetaminophen, but can also occur with most prescription pain relieving drugs. Rebound headaches are more common after prolonged high doses of pain medicine, but sensitive individuals may experience them after a single dose.

A rebound headache is typically a dull low-grade pain. It usually occurs in the morning since no medicine has been taken since the night before. Most people respond to the pain by taking more of their pain reliever of choice with breakfast. Does this sound like you?

Rebound headache is not only limited to those who take pain relievers. Caffeine is a common cause of it, too. Most people who drink 3 or more cups of coffee per day experience some headache if they don't get their morning cup of wake up juice. Try going a day without coffee, cola, or other sources of caffeine and see how you do.

The only way to get rid of rebound headache is to stop using the causative drug. Yes, this means that you will have a day or two of headache. There are some prescription medicines that can ease the discomfort for those who have a serious problem with this form of drug withdrawal, but they usually are not necessary for withdrawal from non-prescription drugs.

I'd suggest that you stop taking pain relievers and stop consuming caffeine. Your headache will probably be gone in 24 to 48 hours. If it isn't, then you should see your doctor.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.