Treatment

To break the cycle of medication overuse headaches, you'll need to restrict your pain medication. Depending on the drug you're taking, your doctor may recommend stopping the medication right away or gradually reducing the dose.

Breaking the cycle

When you stop your medication, expect your headaches to get worse before they get better. Drug dependency may be a risk factor for drugs that result in medication overuse headaches, and you may have withdrawal symptoms such as:

• Nervousness
• Restlessness
• Nausea
• Vomiting
• Insomnia
• Constipation

These symptoms generally last from two to 10 days, but they can persist for several weeks.

Your doctor may prescribe various treatments to help alleviate headache pain and the side effects associated with drug withdrawal. This is known as bridge or transitional therapy. Treatments may include nonsteroidal anti-inflammatory drugs, corticosteroids or dihydroergotamine, an ergot that may be given through a vein (intravenously).

There's debate over how much benefit bridge therapy may offer, and whether or not one drug is more effective than others. Withdrawal headaches tend to improve in less than a week.

Hospitalization

Sometimes it's best to be in a controlled environment when you stop taking pain medication. A short hospital stay may be recommended if you:

• Have other conditions, such as depression or anxiety
• Are taking high doses of drugs that contain opiates or the sedative butalbital
• Are abusing substances such as tranquilizers, opioids or barbiturates

Preventive medications

Preventive medications may help you break the cycle of medication overuse headaches. Work with your doctor to avoid relapsing and to find a safer way to manage your headaches. During or after withdrawal, your doctor may prescribe any of the following daily preventive medications:

• An anticonvulsant such as topiramate (Topamax, Qudexy XR, Trokendi XR)
• A tricyclic antidepressant such as amitriptyline or nortriptyline (Pamelor)
• A beta blocker such as propranolol (Inderal, Innopran XL)
• A calcium channel blocker, such as verapamil (Calan, Verelan, others)

These medications can help control your pain without risking medication overuse headaches. If you're careful, you may be able to take a medication specifically meant for pain during future headache attacks. Be sure to take medications exactly as prescribed.

Injections

Injections of onabotulinumtoxinA (Botox) may help reduce the number of headaches experienced per month as well as headache severity.

Cognitive behavioral therapy (CBT)

During this talk therapy, you learn ways to cope with your headaches. In CBT, you also work on healthy lifestyle habits and keeping a headache diary.