There are many products consumed by migraineurs that have the potential to cause a rebound headache. Here I will list the problematic products and tell you a little about my experience with this problem.
Products with potential for rebound headaches:
1. Caffeine (and this comes in many forms including coffee, soft drinks, tea, over-the-counter medications)
3. Butalbital Products
4. Isometheptine Products
Migraines cause a dilation or swelling of the blood vessels. Some drugs cause the blood vessels to shrink in diameter or constrict. The shrinking of this vessel takes the pain away. However, in many cases when these drugs wear off the vessel grows even larger than the premedication period giving the user a REBOUND headache. These products are appropriate and very effective for someone who has INFREQUENT severe headaches or migraines (no more than two per month) but not for me, the chronic migraineur.
Eliminating my rebound causing products was part of my Migrain Plan. When I eliminated caffeine and triptans I was drinking two caffeinated beverages and taking up to four triptans a week. The triptans would allow me to function giving me relief in about one hour time. However, the headaches would return within a 24 hour period leading to another migraine and hence another triptan. It became a cycle and I became a triptan and caffeine junky to survive. My attempt to go cold-turkey off of these products made me feel like a drug addict. The weekend I started my Migraine Plan I was in the midst of an awful migraine. I had triptans and caffeine in my purse and kitchen (and OH how I wanted them) and...I will admit that I had no will power and popped a triptan. The good news is that after popping that triptan, I didn't need another. I think by reducing all of the other triggers and by sticking to my Migraine Plan. I was able to keep the migraine away!
What I do take:
These days I take Aleve, Aspirin, Acetaminophen, or Advil as needed instead of the products that may cause a rebound headache. There have been days that I take multiple doses of Aleve (never exceeding the recommended per day dose) and so far I haven't gone into full blown migraine and it does keep the migraine away. Ice is another great resource for keeping inflammation down.
I take a decongestant only if I have a cold.
I drink a caffeinated coffee and sometimes a coke on a limited basis. I will cover caffeine a little more on this page. In the beginning I went off of it completely. I just want to be honest and admit I am able to consume it now on a limited basis with careful consideration.
Medications that can trigger Migraines
There are many medications that can trigger migraines. I am going to list some prescription medications that can be migraine triggers. For me hormonal contraception was something I had been on in the past for contraception, but recently was using it to regulate my cycle. So, it really wasn't essential for my life or contraception and it was not a problem to eliminate it. Other prescription medications that trigger migraines may be required and important for life and thus not an option to eliminate. However, with advancements in drugs there are many options available now that may be an alternative to those that are migraine triggers. Discussions with healthcare providers can offer insight into whether or not there are other products available to treat the same condition that might not be a trigger to us migraineurs.
1. Hormones (contraception and replacement therapy)
2. Stimulants (some herbal therapies, ADHD medications, diet pills, and bronchodilators)
3. Acne medications
4. Antidepressants (SSRI's)
5. Vasodilators (nitrates for cardiac disease and male erectile dysfunction medications)
The Caffeine Controversy
Caffeine is an interesting product in that it is not widely viewed as a drug, but it is a potent stimulant. As a nurse I used to give it to premature babies in order to stimulate their central nervous system enough to keep those little ones breathing. I listed caffeine under dietary eliminations but it is also used in over-the-counter headache medications and in some prescription migraine meds as well. Again, these products can be very effective for someone who has INFREQUENT severe headaches or migraines. My headaches were frequent and these products were part of my daily routine.
Before I ever started having true migraines, I would very often have severe headaches associated with exercise and stress. I vividly recall medicating myself during tennis matches/tournaments where I would play a few hours in the heat. Not only would I be popping down Excedrin Migraine (65 mg of caffeine), but I would be choking it down with a nice icy cold Coca Cola (35 mg). So a total of 100 mg of caffeine helped me eliminate my headache. I relied on it so much that I never left home without it. At the time it was a miracle drug for me. However, there came I time where the headaches seemed to outgrow the over-the-counter fix and Excedrin and a Coke no longer was the answer to my problem.
I was warned of the potential of rebound headaches caused by caffeine at the
Houston Headache Clinic and told to limit my use to no more than an 8 oz
beverage per day. Some experts recommend eliminating it completely as a potential trigger and as the cause for rebound headaches. I eliminated it completely for 5 months (part of step two in my relief plan) while establishing relief from my migraines. I figured better safe than sorry. I will admit that I partake in an occasional Coke and cup of coffee these days, never exceeding my 8 oz cup a day rule…so far, so good!
It's always good to know what you are ingesting so I read ingredients. Here is a list of some caffeinated products and their caffeine content:
1. Excedrin Extra Strength (65 mg)
2. Bayer Select Maximum Strength Headache Pain Relief (65.4 mg)
3. Goody's Headache Powder (32.5 mg)
4. NoDoz (200 mg)
5. Coffee (Starbucks 150 mg/16 oz)
6. Hot or cold tea (up to 61 mg/ 8oz)
7. Caffeinated Soda (Mountain Dew is highest with 55mg/12 oz)
8. Energy drinks (Red Bull is 80mg/8.4 oz, there are some energy drinks that contain up to 16000 mg per container or 500 mg/oz)--VERY SCARY!