Recurring headaches can be upsetting for the person who repeatedly experiences pain and frustrating for the health care professional who is trying to help. There are many causes for headaches. This means that it can take time to determine what may be causing your headaches or making them worse. But take heart.  With a careful, organized approach often the cause and therefore relief can be found. This handout will give you information on how you and your health care practitioner can work together to find the cause of your headaches and start you on the road to feeling better.

Since you have headaches that keep coming back, you have most likely talked with your health care practitioner about the problem. But if you have not, that is the first step. The clinician will ask you questions to help determine if your headaches are from a common cause such as tension or if they could be symptoms of a more serious condition. Headaches caused by serious conditions are rare.

We recommend a three-step plan:

• determine if medication is causing the recurring headaches,
• identify and remove the triggers causing the headaches, and
• start therapy to prevent further headaches.

How can I learn if medication is causing my headaches?

Identify current medication

Ironically the very medication that you started taking to treat headaches may now be causing them to recur. This type of headache is from overuse of medication. The most common medications that can cause overuse headaches are Butalbital, opioids, acetaminophen (Tylenol), caffeine and aspirin. But any medication used to relieve pain can cause the headaches. Combinations of medicine are especially likely to cause them.

Create a plan to stop the medication

It is important to stop your current pain medications before taking steps to prevent future headaches. The longer you have used a pain medication, the longer it will take to come off of it. Some types of pain medications (e.g., opioids, barbiturates and benzodiazepines) should be withdrawn slowly over a 2-4 week period. Other drugs (e.g., non-steroidal anti-inflammatories, triptans, ergot alkaloids, and acetaminophen) can usually be stopped more abruptly without causing problems. If you can tolerate going “cold turkey”, it is the fastest way to break a cycle of recurring headaches. Allow at least two weeks for the headaches to decrease in number. Stopping the drug can lead to a severe rebound headache. If this happens, your health care practitioner can prescribe bridge therapy to help you through the difficult time.