Drug-Related Headaches: How to Spot and Stop Medication Overuse Headaches

Ever taken painkillers for a headache, only to have it come back worse a few hours later? If you’ve been reaching for ibuprofen, Excedrin, or triptans more than 10 days a month, you might not have a worsening migraine-you could be causing your own headaches. This isn’t rare. About 1 in 50 people worldwide suffers from medication overuse headache (MOH), and most don’t realize it’s the medicine itself that’s the problem.

What Exactly Is a Drug-Related Headache?

Medication overuse headache (MOH), sometimes called rebound headache, happens when frequent use of headache meds turns occasional headaches into daily ones. It’s not a new type of headache. It’s your brain getting stuck in a loop: you get a headache, you take medicine, it goes away, then comes back harder, so you take more. Over time, your nervous system gets rewired to expect the drug. When it’s not there, your brain screams louder.

The International Headache Society officially defined MOH in 2018, and since then, doctors have seen it more clearly. It’s not about being addicted to painkillers-it’s about your body adapting to them. People with migraine or tension-type headaches are most at risk. In fact, 12% of U.S. adults have migraine, and 38% globally get tension headaches. When those folks use acute meds too often, MOH creeps in.

Which Medications Cause the Most Problems?

Not all pain relievers are created equal when it comes to triggering MOH. Some are far more dangerous with frequent use:

• Opioids (oxycodone, hydrocodone, tramadol) and butalbital (found in Lanorinal, Butapap) are the worst. Just 10 days a month is enough to trigger MOH.
• Triptans (Imitrex, Zomig) used 10+ days a month carry high risk. Many migraine patients don’t realize these are part of the problem.
• Combination analgesics like Excedrin (caffeine + aspirin + acetaminophen) are moderate risk-15+ days a month can do it.
• NSAIDs like ibuprofen (Advil) and naproxen (Aleve) are lower risk, but still dangerous if you hit 15+ days a month. Some experts say even 10 days is too much.

Here’s the twist: acetaminophen (Tylenol) alone is safer than most, but when mixed with caffeine or aspirin, it becomes a trigger. And caffeine? It’s sneaky. It boosts painkiller effectiveness but also rewires your brain to crave it. Withdraw from caffeine after long-term use? You’ll get a pounding headache.

How Do You Know If It’s MOH?

MOH has clear diagnostic rules:

• You have headaches on 15 or more days per month.
• You’ve been using acute headache meds for more than 3 months.
• You’re hitting the overuse threshold for your drug class (10+ days for opioids/triptans, 15+ for others).

And here’s what it feels like: your headaches are constant, dull, and worse in the morning. They might feel like a tight band around your head. You might also get nausea, irritability, trouble sleeping, or brain fog. Many people think they’re just getting worse migraines-until they stop the meds and realize the headaches faded.

A headache diary is your best tool. Write down every headache, what you took, when, and how long it lasted. If you’ve been taking painkillers more than 10 days a month for 3 months straight, MOH is likely.

What Happens When You Stop the Meds?

Stopping is the only cure-but it’s not easy. Withdrawal hits hard. In a 2022 study of 350 MOH patients:

• 92% had worse headaches during withdrawal.
• 68% felt nauseous.
• 42% vomited.
• 29% dropped in blood pressure.

Most people feel awful for 2 to 7 days. For some, it lasts up to 4 weeks. But here’s the good news: after that, most people see dramatic improvement. One Reddit user wrote: “After 5 weeks off Excedrin, my headache days dropped from 28 to 9 per month.”

How you stop matters. For opioids or butalbital, quitting cold turkey can be dangerous. Tapering slowly under medical supervision is safer. For triptans or NSAIDs, stopping all at once often works fine-though you’ll need backup plans for pain.

What Should You Use Instead?

During withdrawal, you need rescue meds-but not the ones you’ve been overusing. Doctors recommend:

• Acetaminophen (Tylenol), limited to 2 days a week.
• Low-dose NSAIDs like naproxen, used sparingly.
• Non-medication tools: ice packs, relaxation techniques, acupuncture.

And here’s the game-changer: gepants. These are newer migraine drugs like Ubrelvy, Nurtec ODT, and Zavzpret. Unlike triptans, they don’t seem to cause rebound headaches. Clinical trials show they’re effective for acute attacks without triggering MOH. If you’re stuck in the cycle, ask your doctor if one of these could work for you.

Another option is preventive medication. Once you stop the overused drugs, you need something to stop headaches before they start. Proven options include:

• Topiramate (40-100 mg daily)
• Propranolol (80-160 mg daily)
• CGRP monoclonal antibodies (Aimovig, Ajovy, Emgality)-monthly injections with 50-60% success rates
• Atogepant (Qulipta)-a new oral preventive approved by the FDA in January 2024 specifically for chronic migraine with MOH history

Studies show that starting prevention right after withdrawal cuts relapse by half. Without it, 78% of patients are back to daily headaches within 3 months.

Why Do Doctors Miss This?

Many patients don’t realize their meds are the problem. One Reddit user said: “I thought my doctor was blaming me.” That’s common. Doctors often focus on treating the headache, not the pattern. And with so many headache types, MOH can be easy to miss.

But experts say it’s not the patient’s fault. Dr. Peter Goadsby from King’s College London says: “MOH represents a failure of treatment strategy, not patient behavior.” Most people start with legitimate prescriptions or OTC meds, then keep using them because the headaches keep coming. It’s a trap built into how we treat pain.

What’s New in 2025?

The field is moving fast. In 2023, researchers identified 12 genetic markers linked to MOH susceptibility. That means someday, a simple blood test could tell you if you’re at higher risk-so you can avoid certain meds before you start.

Also, the Migraine Research Foundation is funding studies on transcranial magnetic stimulation (TMS) as a non-drug tool to ease withdrawal. Early results show it reduces headache intensity during detox.

And new drugs are coming. The American Migraine Foundation predicts that by 2035, “rescue medications with built-in overuse safeguards” could cut MOH cases by 40-50%. These would be pills that automatically limit dosing or require a doctor’s approval after a certain number of uses.

What Should You Do Right Now?

If you’re taking headache meds 10+ days a month:

1. Start a headache diary for 4 weeks. Track every headache and every pill.
2. Don’t quit cold turkey unless you’re on opioids or butalbital-talk to your doctor first.
3. Ask about gepants or CGRP inhibitors as safer alternatives.
4. Request preventive treatment before or right after stopping your current meds.
5. Use non-drug tools: sleep hygiene, stress reduction, hydration, and regular meals.

It’s not about willpower. It’s about biology. Your brain changed because of the meds. Healing it takes time, support, and the right plan. But it’s absolutely possible. Thousands of people have done it. You can too.