These types of headaches are referred to as drug-induced rebound headaches and represent a major challenge in the management of acute migraine. Analgesic rebound contributes to the chronicity of headache and reduces the effectiveness of other pharmacological and nonpharmacological measures. The possibility of analgesic rebound headache should be considered if the patient reports analgesic use more than three times a week for headaches, and especially if daily use is reported. Many patients overmedicate with OTC drugs, because they hope to prevent a mild or moderate headache from evolving into an incapacitating one, or they routinely take analgesics at night to prevent disabling headaches during the day. As the use of medication increases or becomes routine, a vicious cycle of rebound headaches is created, followed by additional analgesic use, evolving to a chronic daily headache.
Headaches occur in a patient who uses immediate-relief medications very frequently.
Headache itself varies in its severity, type and location. Headaches are accompanied by asthenia, and nausea, and other gastrointestinal symptoms. There is a drug-dependent rhythmicity of headaches. Early morning headaches are frequent. There is evidence of tolerance to analgesics over time.