Overusing some medications may trigger chronic migraine. Taking too much headache medication can also turn occasional migraine attacks into chronic migraine.

Migraine is a neurological disorder often featuring severe head pain. Migraine attacks typically involve throbbing on one side of the head. They can last anywhere from 4–72 hours.

People can have chronic or episodic migraine. Episodic migraine involves head pain with migraine symptoms that occur less than 15 days per month.

Chronic migraine is a persistent condition involving head pain at least 15 days per month for more than 3 months.

Chronic migraine affects 0.5–5% of people, according to a 2019 narrative review. In some cases, episodic migraine may develop into chronic migraine.

Taking headache or migraine medication too frequently can lead to medication overuse headache (MOH).

This article provides an overview of MOHs, treatments, and when to speak to a doctor.

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MOHs are frequent headaches that develop when a person takes pain medication for their symptoms too often. They are also known as rebound headaches or drug-induced headaches.

MOHs affect about 1% of all people but are more common in women.

People with migraine often develop MOH after taking abortive migraine medications too frequently.

This can lead to a cycle of head pain.

Medications that may cause medication overuse headaches

Medications that can cause MOHs include:

  • analgesics, such as:
    • acetaminophen (Tylenol) or paracetamol
  • nonsteroidal anti-inflammatory drugs such as:
    • acetylsalicylic acid (Aspirin)
    • ibuprofen (Advil, Motrin)
  • ergotamine
  • triptans
  • opioids

Overuse of multiple medications can also cause rebound headaches, even if a person does not overuse individual medications.

Experts do not yet fully understand how some headaches become chronic. However, research suggests overusing some medication increases the risk of episodic migraine becoming chronic.

According to a 2021 review, 3 in 4 people with chronic migraine report overusing headache medication.

In a 2019 review, researchers investigated data on migraine treatments and medication. They noted that medications containing opioids and barbiturates have a strong association with MOHs.

They also note that people who take triptans more than 2–3 days per week may develop MOHs.

Medication overuse headaches

Treatment for MOH involves completely weaning a person off the pain medication they are taking and finding a more effective alternative.

Doctors may wean a person off their medication abruptly or slowly decrease their dosage over several weeks.

Depending on the type of headache disorder a person has, a doctor may recommend preventative treatments such as:

  • preventative migraine medications
  • nonpharmaceutical treatments, such as
    • cognitive behavioral therapy (CBT)
    • biofeedback therapy to help people monitor and be aware of their bodily responses to stress
    • relaxation training
    • lifestyle modification with trigger avoidance

People who have four or more migraine days a month may also qualify for preventive migraine medications.

Chronic migraine

Most people with chronic migraine need preventive treatment. Preventive medications include:

  • anticonvulsant medication
  • antidepressants such as
    • selective serotonin reuptake inhibitors
    • tricyclic antidepressants
  • medications that lower blood pressure, such as:
    • antihypertensives
    • angiotensin receptor blockers
  • beta-blockers
  • anti-nausea medication
  • CGRP antibodies, such as erenumab (Aimovig)
  • Botox injections

Doctors may also recommend the following in addition to medication:

  • behavioral management techniques, such as:
    • CBT
    • exercise
    • stress management therapy
  • acupuncture
  • dietary changes or supplements

People with chronic head pain should seek professional medical attention for an accurate diagnosis.

Some other serious conditions or injuries may cause head pain. A healthcare professional will work to rule out other causes of a person’s symptoms and recommend appropriate treatment.

Overusing pain relief medication can cause episodic migraine to turn into chronic migraine. Certain medications may be more likely to cause MOHs.

Doctors treat MOHs by weaning people off the medication, causing rebound headaches. They may also recommend other treatments for recurring head pain or chronic migraine.