Q. I have a long history of tension headaches and usually get relief by taking acetaminophen. Lately, the medication relieves the headache, but then the pain returns later in the day. Can acetaminophen lose its effectiveness, or could the problem be something else?
A. Any headache that's new or worsening should be evaluated by your doctor. He or she will try to diagnose the cause of the headache by reviewing your medical history and performing a physical examination.
Your headache fits the description of a medication overuse headache (MOH). In this case, the pain is caused by the very medications taken to relieve the pain. Medications most commonly associated with MOH are opioid pain relievers (such as codeine and oxycodone) and medications containing the barbiturate butalbital (such as Fioricet). Acetaminophen and ibuprofen have also been linked to MOH.
What causes MOH? Some experts suspect that repeated use of medication somehow sensitizes the nervous system to pain. Another factor may be the tendency for headache-sufferers to take more pain relievers than they really need: They're so worried about the headaches that they take pain relievers as a "pre-emptive strike." This further increases their consumption of pain medications.
MOH is hard to treat because it requires that a person stop using all headache medications, which of course leads to pain. Your doctor can guide you on how to taper off the medications causing the problem, and perhaps offer some medication temporarily to help you through the withdrawal period. Once the offending medication has been stopped, most headaches improve. You may benefit from daily preventive treatment, such as tricyclic antidepressants for migraines. -- William Kormos, M.D., Editor in Chief, Harvard Men's Health Watch
A. Any headache that's new or worsening should be evaluated by your doctor. He or she will try to diagnose the cause of the headache by reviewing your medical history and performing a physical examination.
What causes MOH? Some experts suspect that repeated use of medication somehow sensitizes the nervous system to pain. Another factor may be the tendency for headache-sufferers to take more pain relievers than they really need: They're so worried about the headaches that they take pain relievers as a "pre-emptive strike." This further increases their consumption of pain medications.
MOH is hard to treat because it requires that a person stop using all headache medications, which of course leads to pain. Your doctor can guide you on how to taper off the medications causing the problem, and perhaps offer some medication temporarily to help you through the withdrawal period. Once the offending medication has been stopped, most headaches improve. You may benefit from daily preventive treatment, such as tricyclic antidepressants for migraines. -- William Kormos, M.D., Editor in Chief, Harvard Men's Health Watch
