Medication Adaptation Headache

Medication Adaptation Headache is an incredibly frustrating and debilitating experience. In this article, we will define Medication Adaptation Headache, discover medication guidelines, how medication contributes to chronification of migraine, and ways to get out of this cycle.

What is it?

Medication Overuse Headache is a medical diagnosis given to people with headache disorders experiencing 15+ attack days per month for 3+ months with the presence of frequent medication use.

You’ll notice that the diagnosis is “Medication Overuse Headache”, whereas we are referring to the experience as “Medication Adaptation Headache” today. The language we use around migraine is incredibly important and can serve to minimize stigma, raise awareness, and encourage education.

“Medication Overuse Headache” is an official diagnosis in the International Classification of Headache Disorders (ICHD), but is a title that is stigmatizing by placing blame on the patient for “overusing” medication. In non-clinical settings, “Medication Adaptation Headache” is a more appropriate title.

If this idea of migraine language changes sparks curiosity in you, click [here (CHAMP)] or [here (Migraine AUS)] for some of my favorite language guides.

Medication guidelines

Each type of rescue medication has a recommended amount of doses each month:

Over-the-counter painkillers: 15 days

  • Ibuprofen
  • Naproxen
  • Aspirin
  • Acetaminophen

Combination painkillers: 10 days

  • Excedrin

Triptans: 10 days

  • Sumatriptan 
  • Zolmitriptan
  • Rizatriptan
  • Almotriptan
  • Frovatriptan
  • Eletriptan

Opioids/Narcotics: 10 days 

  • Not often prescribed

Caffeine should also be limited, the recommendation is no more than 200mg per day, about 2 cups of coffee. [Click here] for my article all about caffeine.

Unfortunately, taking medication for any reason will count. If you have back pain and take a painkiller, your body doesn’t “know” that it’s for your back and has nothing to do with your head. It is metabolized the same way and can contribute to Medication Adaptation Headache.

Why does this happen??

I consider Medication Adaptation Headache the “cherry on top” of the worst pie ever. It is incredibly frustrating and counter-intuitive. Medication is supposed to help us, and people with migraine are so often told to treat as early as possible. 

This is one of the reasons I dislike the term “Medication Overuse Headache”, that we really can’t be to blame for falling into this cycle. If you’re treating every attack as early as possible, but having more than 10 attacks a month… you believe you’re doing what you’re meant to do, but you’re actually putting yourself at risk for much more pain. (And – at least in my experience – this isn’t discussed in medical appointments until it is much too late.)

So again, why does this happen?

  • One of the reasons is that traditional rescue medication was designed for episodic migraine, assuming the patient only needs a few doses each month.
  • Central sensitization is a feature of chronic pain conditions, and is thought to be aggravated by frequent medication use. Central sensitization is an increased responsiveness of the central nervous system (or a “hypersensitivity”). [Click here] for a scientific article to read more about central sensitization.
  • There are changes to the “serotonergic system” with frequent medication use. Serotonin plays an important role in migraine – triptans (the “gold standard” for migraine treatment) are serotonin receptor antagonists.

How can we avoid this or treat it?

The best way to determine whether you’re experiencing Medication Adaptation Headache is to keep records of your attack days and how often you’re taking medication.

When experiencing Medication Adaptation Headache, you may notice the following:

  • The quality of your pain may be the same, but more frequent.
  • You’re making more frequent trips to the pharmacy. (I recall being turned away because my insurance wouldn’t cover the frequency of my refills!)
  • Your medications are less effective.

A crucial part of avoiding/treating Medication Adaptation Headache is withdrawal from frequent medications. This can be terrifying and frustrating because with frequent attacks, you’re left being unable to treat debilitating pain. Many of us find ourselves rationing medications and deciding if each attack is “worth” treating.

Speak to your physician for individualized guidance, they can help guide you. I’ll share what has worked for me and what I recommend to my clients here:

  • Personally, I never had to fully eliminate medications. (Again, speak to your physician, your situation may be different.) Keeping a tally each week to track my medication use helped me stay under the threshold, and brought me out of this cycle.
  • Find alternatives that successfully bring you relief. There are many options to treat migraine attacks. [Click] my Instagram post to read through alternatives I recommend.
  • Prevention of attacks should be your main priority. Ask your physician about prevention medications and find ways to strengthen your threshold against migraine.
    • If you need help with prevention, schedule a call with me. In my MEND Method, we work together to strengthen your threshold against migraine through Mindfulness, Exercise, Nurture, and Diet.

More information:

Earlier I discussed how traditional rescue medication is designed for episodic migraine. Luckily, this is changing.

  • Our anti-CGRP medications today have transitioned chronic migraine to episodic migraine, high frequency to low frequency of attacks. They dramatically reduce the need to treat attacks in the first place.
  • Gepants are oral CGRP antagonists that are rescue medications that seem to have no correlation to Medication Adaptation Headache. In fact, the more doses patients take, the less attacks they seem to have. (I’m begging for this prescription at my next neurology appointment!)

In this year’s Migraine World Summit (2021), Dr. Stewart Tepper had an interview titled “Medications That Make Migraine Worse”. I would highly recommend giving this interview a listen.

Have you experienced Medication Adaptation Headache? Are you stuck in it currently? Let me know your thoughts about this topic!

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