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Message: <blockquote data-quote="azbass" data-source="post: 2726879" data-attributes="member: 557015">Could you be giving yourself a headache? The answer is yes, if you take over-the-counter remedies like Tylenol, aspirin or Advil more than twice a week. Excessive amounts of common medications can dull your body’s natural pain relievers and actually cause more headaches, says Paul J. Millea, MD, Assistant Professor of Family and Community Medicine at the Medical College of Wisconsin.Dr. Millea and another Milwaukee physician, Jonathan J. Brodie, MD, discussed the problem of so-called “rebound headaches” in an article about tension headaches they published last year in American Family Physician, a peer-reviewed journal of the American Academy of Family Physicians. Dr. Brodie has completed a faculty development fellowship at the Medical College.“Frequent, severe headaches are often the reason people make appointments,” says Dr. Millea, who sees patients at the Medical College’s Lincoln Avenue Clinic, where one of his areas of patient emphasis is management of chronic pain. He estimates 80% of his patients with pain problems also complain of a headache. For some, he says, the headache may be secondary to another condition (sinus congestion, allergy or tumor, for instance), but often recurring headaches themselves are the primary cause of pain. “It’s a perplexing problem that primary care physicians often see,” he says, adding that some physicians might not always be aware of how to treat the condition.When Tension Headaches Become ChronicIn a patient handout accompanying their article, the authors noted the difference between tension headaches and chronic daily headaches:Tension headaches: “A tension headache,” they wrote, “causes feelings of tightness or pressure on your forehead or the sides of your head. The pain often moves into your neck and shoulders.”Chronic daily headaches: “If you have a headache every day or nearly every day, it’s called chronic, and usually it’s a rebound headache brought on by overusing headache medicines more than two times a week. Rebound headaches can also occur in people with migraine who use pain medicine often.”In their article, Drs. Millea and Brodie recommend that patients (and their physicians) consider alternatives to medications for relief of frequent, tension headaches:* Patients who smoke should stop. “Smoking may increase the risk of tension headaches,” the patient handout said.* Biofeedback and physical therapy. “These may help you control your headaches by relaxing the muscles in your neck and head.”* Behavioral treatment and relaxation training. “These can teach you new ways to deal with stress.”* Acupuncture or chiropractic treatments. “These may help relieve and reduce the number of headaches you get.” (Dr. Millea’s practice focus includes acupuncture and osteopathic manipulation.)For occasional headache relief, Dr. Millea says, over-the-counter analgesics are okay – if patients follow package instructions. “Over-the-counter drugs are recognized as generally safe,” he says. “Where patients get in trouble is when they consume large amounts every day.” And overuse of anti-inflammatory drugs like aspirin and ibuprofen can irritate the gastrointestinal system and cause bleeding. Sometimes these drugs can even cause liver and kidney damage.How much medication is safe to take? Dr. Millea says a safe dosage is no more than 650 to 1,000 milligrams (approximately two tablets) of acetaminophen (such as Tylenol) at a time, every four hours; or 400 milligrams (two tablets) of ibuprofen (such as Advil) every six hours. “It’s important to note that it’s safe to take over-the-counter analgesics twice a week. In fact, most tension headaches should go away with one dose,” he adds.Withdrawal May Stop the CycleThose experiencing rebound headaches, however, will have to wean themselves off these drugs. And that is not easy.“Treating chronic daily headaches can be a challenge for you and your doctor,” Drs. Millea and Brodie caution. “Chronic daily headaches may improve if you stop overusing pain relievers and start taking medicine to prevent the headaches. This may be hard to do, because your headaches may get worse at first when you cut back on pain relievers.“Some people have withdrawal symptoms when they stop taking pain medicines. They feel nervous or restless, and have nausea, diarrhea, trouble sleeping and trembling. Tell your doctor if you get these symptoms.” For his patients trying to break the rebound cycle, Dr. Millea might prescribe a 5-to 10-day course of cortisone to help them tolerate the withdrawal effects.“Your daily headaches should get better after two weeks of not taking pain relievers,” the article said. “If you had migraines before you got chronic daily headaches, the migraines might return. Talk to your doctor about which medicines may be right for you. It is also very important to talk to your doctor about any other medicines you are taking.”Ruling Out Other CausesDrs. Millea and Brodie recommended that their fellow physicians conduct a thorough examination of patients with frequent headaches to rule out underlying causes, including mental health issues. “There may be more going on than the pressures of daily life,” he observes. “Some patients with tension-type headaches might also be suffering anxiety, depression or psychosocial stress. They use their headaches as the ticket to getting in to see their doctor.”And anyone who experiences more than two or three tension headaches a month, or anyone who regularly takes over-the-counter analgesics three or four times a week, should also see their physician, Dr. Millea advises.Barbara AbelHealthLink Contributing WriterPaul J. Millea, MD is an Assistant Professor of Family and Community Medicine in the Medical College of Wisconsin Department of Family and Community Medicine.</blockquote>

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