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What if the medication helping you survive today's migraine is quietly making tomorrow's headache more likely?
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Welcome to Migraine Heroes, a podcast for people living with chronic migraines with years of pain,
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misunderstanding and lack of answers. I'm Diane Ducarme.
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I've helped more than a thousand people reduce the burden of migraines and feel more in control.
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My mission in life? To help a million people.
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Each episode brings you grounded insight into what your body might be asking for and what can truly help.
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Just to keep you fully supported, this podcast is educational.
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For diagnosis or medication, always work with your doctor.
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Now, take a breath and let's dive in.
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In this episode, you will learn how to recognize when frequent migraine treatment may be
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contributing to a cycle of increasingly frequent headaches.
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Why this happens in the brain and why it's not a sign that you're weak, dependent or doing migraine treatment wrong.
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And how to begin analyzing and breaking the cycle safely,
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including a few steps you can take at home today without suddenly stopping medication on your own.
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Stay with me till the end, because by the end of this episode,
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you will have a good sense as to whether you are experiencing rebound migraines and what first steps to take.
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So first, I want to acknowledge how unfair the situation is.
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You experience pain, so you take the medication you were given to relieve that pain. It works, at least temporarily.
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So naturally, you reach for it again when the pain returns. There's nothing irrational about that. You're not careless.
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You're not lacking discipline. You're trying to function.
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You're trying to work, care for your family, sleep, think and get through the day.
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When medication overuse develops, it usually begins as a reasonable response to a very real pain.
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So what is actually a rebound headache? The medical name for rebound headache is
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Medication Overuse Headache, MOH, and according to the International Classification of Headache Disorders,
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3rd edition, it is diagnosed, buckle up, when someone with a pre-existing headache disorder
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develops headaches on at least 15 days per month, while regularly overusing one or more medications
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intended for acute headache relief for more than 3 months. The headache is not better explained by
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another diagnosis. It usually improves when the excessive medication use is addressed,
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although improvement is not immediate or guaranteed in every person.
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Now, the word overuse can sound accusatory, but it's a clinical description, not a moral judgment.
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It does not mean that you intentionally misused medication. It means that the number of medication
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days has crossed the level associated with worsening headache frequency in susceptible
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people. And this is an important distinction. Medication Overuse Headache is not simply a
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headache that appears every time a tablet wears off. It is usually a broader transformation in
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which an episodic headache condition becomes chronic or almost continuous. The headache may
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become less predictable, less responsive to treatment, and increasingly difficult to separate
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into individual attacks. So how much medication is considered too much? Well, the threshold is going
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to depend on the type of medication. For tryptoms, ergotamine medicine, opioids, and combination pain
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medicines, regular use on 10 or more days per month for longer than 3 months can meet the overuse
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threshold. For more simple pain relievers, including paracetamol, also called acetaminophen,
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and non-steroidal anti-inflammatory medicines, such as ibuprofen, the threshold is usually 15
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or more days per month for longer than 3 months. Now, these are medication days. They're not the
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total number of tablets. Taking 3 doses on Monday is still 1 medication day in that definition.
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Taking 1 dose on Monday, Wednesday, and Friday will count as 3 medication days. And the threshold
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are useful warning lines, but the International Headache Society also notes that they are based
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substantially on expert consensus, a bit like that definition. Not everyone who crosses them
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develops medication over his headache, and some vulnerable people may notice worsening before
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reaching those thresholds. Now, this means the goal is not to become frightened of medication,
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like treatments are important and they can be life-changing at times, but the goal is to notice
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when you are needing them so frequently that your migraine may require a stronger preventative
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strategy rather than simply more rescue treatment. So, how widespread is this problem? There was some
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research published in the Lancet Neurology in 2019, and it estimated that medication over
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a headache affects approximately 1 to 2% of the general population over a one-year period.
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It occurs most commonly in people with migraine and is seen more frequently among people who also
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experience anxiety, depression, or other chronic pain condition. So, let me mix this really by sharing
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the stories of two people I've worked with. So, one was a man living in Australia, and the other
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one was a woman based in the United States. And their circumstances were different, but the pattern
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they described was remarkably similar. So, they would take medication to get through a severe migraine,
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and the medication might bring some relief, not full relief, but some relief that day. But by the
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next day, by the following day, the headache would return. So, as a result of that, they would take
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medication again, and then the migraine would come back again, and the cycle would continue
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all day long, for a decade literally. And so, from their perspective, it felt as though the treatment
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taken yesterday was helping to create the pain they were facing today. Of course, it's not possible
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to prove that one particular dose directly caused the next day's migraine. Medication over a headache
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is more complex than that, and even the definition you heard is quite complex. But what was clear
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was that they had become trapped in the pattern of pain, of temporary and partial relief, and then
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returning pain, with fewer and fewer opportunities for the nervous system to settle. And science
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estimates that medication over a headache affects approximately one to two percent of the general
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population. And I want to be honest, that number, it feels surprisingly low to me. The people we
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serve often live with extremely frequent and severe pain. So, within that population, we
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encounter this pattern far more often than a general population statistic might suggest.
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So, that doesn't mean that the science is wrong. It means that we're looking at two different groups.
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And so, the scientific estimate describes the population as a whole, including millions of
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people who rarely or never experience migraine. Our work focuses on people with a much higher
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migraine burden, people who may need acute medication many times each month, simply to
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keep functioning. So, when you hear one to two percent, remember that this is an average across
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the whole population. Among people living with chronic or frequent migraine, medication overuse
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is a much more relevant and immediate concern. Now, how can a helpful medication begin feeding
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the cycle? So, the complete mechanism is still being studied. Scientists do not believe that
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one simple chemical remains in your body and directly produces the next headache.
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The leading explanation is that repeated exposure to acute medication in a brain overly vulnerable
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to migraine may alter the systems that regulate pain. So, migraine involves the trigeminal pain
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pathways, the brainstem, sensory processing networks, and signaling molecules. And so,
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with increasingly frequent attacks in medication use, pain pathways may become sensitized.
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And sensitization means that the nervous system begins responding more strongly to signals that
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it would previously have tolerated. Light feels brighter, sound feels sharper, touch becomes
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uncomfortable, and ordinary changes in sleep, mood, hormones, or stress begin provoking attacks
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more easily. An experimental work published in Frontiers in Molecular Neuroscience, that paper
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in 2023, also found evidence of inflammatory signaling and central sensitization in an animal
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model involving repeated somatotryptin exposure. Animal studies cannot prove that precisely the
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same processes occur in humans, but they help researchers investigate why repeated treatment
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exposure may leave pain pathways increasingly excitable. And yes, I am sorry for these animals.
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It feels like a lot to go through. So, there's a powerful learning loop. You feel the earliest sign
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of an attack. You remember how disabling the previous attack became. You understandably take
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medication quickly. You experience relief, which teaches the brain that the medication is essential
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for safety. But when headache days become very frequent, the opportunities to take medication
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multiply. And before long, fear of the next migraine and the need to remain functional
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can become part of the cycle. That does not make the condition imaginary or purely psychological.
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It means that pain, biology, anticipation, behavior, and survival are interacting. The
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brain is doing what brains do, learning from repeated danger and relief. Now, what happens
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when the medication is reduced? So, this is often the part that people fear the most, and for good
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reason. When an overused medicine is withdrawn, the headache may temporarily become worse,
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and people may experience nausea, vomiting, sleep disturbance, restlessness, anxiety,
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appetite changes, low blood pressure, or raising heartbeat. But withdrawal must be individualized.
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European guidance states that simple pain relievers may sometimes be stopped abruptly
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or sharply restricted under medical guidance, and that others generally require gradual tapering
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and closer supervision. Some people need outpatient support. Others will require specialist or
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hospital care because of the medication involved, previous withdrawal failures, psychiatric
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conditions, or the severity of their symptoms. So, please do not listen to this episode and
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suddenly throw away your medication. This is not the idea. This is not the intent. The safest plan
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depends exactly on what you take, how often you take, the dose, your other health conditions,
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and the severity of your migraine. When it comes to medication, speak to your doctor, and if you're
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not convinced by that doctor, seek a second opinion. So, let's go east for a minute and seek a bit of
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wisdom there. Now, it's important to understand that medication overuse headache does not exist
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in a classical or a standalone diagnosis in traditional Chinese medicine, and that is partly
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because traditional Chinese medicine developed long before modern migraine medicines, and partly
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because it organizes illness differently. So, Western neurology defines medication overuse
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headache through the relationship between a pre-existing headache disorder, the number of
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headaches days, and the frequency with which acute medication is taken. Traditional Chinese medicine
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does not traditionally diagnose headaches using medication day thresholds. Instead, it's going to
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look at the complete pattern being expressed by the individual. Now, I do have a wonderful
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traditional Chinese medicine practitioner. His name is Eddie, and I absolutely adore him. Whenever he
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gives me herbs, he usually gives them for five days at a time. Why? Because after five days, the body
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may already have changed. Traditional Chinese medicine sees the body as completely dynamic,
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not fixed. What is appropriate today may not be appropriate several weeks from now. A particular
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formula may help correct an imbalance in the short term, but taking exactly the same combination
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indefinitely may eventually stop being helpful, or may even begin pushing the body in the opposite
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direction. So, that principle is very similar to how we work at Migraine Heroes. When we use food
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to support the body, we generally focus on adding rather than simply removing. We add foods intended
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to support the underlying imbalances and root causes we are observing. But we do this dynamically.
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We do not keep every person on exactly the same foods in exactly the same quantities forever.
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You may identify an imbalance and begin correcting it. You support it, support it, and support it.
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Eventually, you reach a point of greater balance. But when you continue pushing beyond that point,
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you can overcorrect. And that overcorrection may create a new imbalance with a different
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migraine pattern. And this is something we've been observing clinically since 2019.
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The body's needs change as the body changes. A strategy that was right at the beginning of
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someone's journey may need to be adjusted later. So, what do you actually do? This is a tough one,
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a really tough one. The first step, I believe, is to measure. You need to start tracking your
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headache days, your migraine symptoms, and every day on which you take acute medication. You can do
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that free of charge on the Migraine Heroes app and generate a doctor report. You can use any other
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migraine app. You can also write everything down manually. That's great too. The method matters
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far less than having a clear and honest picture of what is happening. Then take that information
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to your doctor or health practitioner and analyze it together. Look at how often the headaches are
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occurring, how often medication is being used, what happens the following day, and whether any
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patterns are beginning to emerge. From there, you can decide on the safest next step. And I want to
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be honest with you, this can be extremely difficult. In fact, I find this to be one of the
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most difficult parts of supporting people with migraine. I'm continually humbled by the level
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of distress people are carrying. When you have been living with severe pain, it is completely
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natural to feel desperate for something, anything that might help. There's an expression I often
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think about, which is, once bitten, twice shy. And over the course of your life, you may have tried
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treatments that help temporarily, only for the pain to return or even become worse. You may have
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allowed yourself to hope, only to feel disappointed again. And every time that happens, it can leave
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you feeling more cautious, more isolated, and more hopeless. And I'm deeply sorry if that has been your
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experience. You did not fail because the solution stopped working, you were not foolish for hoping
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it would help, and you are not weak because you are frightened of changing something that may be
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giving you even a few hours of relief. This is a difficult topic because there may be no simple
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answer. It requires careful tracking, thoughtful medical guidance, and a great deal of compassion
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for yourself. You do not need to solve this entire cycle today. Begin by observing. Measure first,
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understand second, then make the next decision with support. And remember, every small step you take
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moves you closer to freedom. You are powerful, you are resilient, and you're not alone. Keep rising.
