How To Break Headache Cycle?

Various approaches are used to break the headache cycle, but the problem is to manage the pain during the time in which no analgesics are prescribed. The condition can be managed by controlling the administration of analgesics both in terms of dose and duration.

How To Break Headache Cycle?

How To Break Headache Cycle?

Headache cycle is caused due to the inappropriate pain management from the existing dose of analgesics. Further, the patient is forced to take higher dose of analgesics to manage the pain of rebound headache which further worsens the condition. The problem in breaking the headache cycle of rebound headache is difficult because the only way to manage the rebound headache is to stop the pain medications completely. The patient refuses to accept this approach as they are under tremendous pain due to migraine and rebound headache. Thus, the best approach is to manage the pain of the patients when they are not on analgesics. Following are the approaches that can be used for breaking the headache cycle:

  1. Titrating The Pain Relieving Medication: The medications of pain management should be titrated down either in terms of dose or in terms of frequency so that it does not cause any withdrawal syndrome and the pain experienced by the patient is manageable. Further, the medication may be replaced by other medications which are having a low risk of causing headache cycle.
  2. Bridge Therapy: As already mentioned, the best practice to break from the pain of headache cycle is to completely stop the medications used for pain management. However, this has the adverse effect on the patient as their pain is not manageable. Thus, a therapy known as bridge therapy is usually administered to the patients. Drugs administered under this therapy include drugs such as steroids, dihydroergotamine or IV medications such as valproates. It significantly helps in breaking the headache cycle as this therapy eliminates the use of pain killers completely. Once the analgesics are stopped, rebound headache subsided. The drugs may be given through intravenous administration which has their effect for few weeks.
  3. Prophylactic Therapy: Rebound headache develops when the patient uses analgesics to treat their pain. Thus, another approach may be to manage the migraine through prophylaxis if the frequency of the migraine episodes is high. In the prophylactic therapy, the condition is not managed empirically with the use of general analgesics, ration a rational approach is applied and the drugs used are specific for migraine headaches.
  4. Avoiding Opioids Or Barbiturates: Opioids and barbiturates are the drugs which are commonly known for causing rebound headache and also causes withdrawal syndrome. These drugs can be replaced with other drugs such as dihydroergotamine. Changing to dihydroergotamine can break headache cycle.

Headache Cycle

Rebound headache is a like a cycle of processes which refuses to break unlit various approaches are used to break the cycle. Thus, it seems that rebound headache is a never ending process and the patient may not ever get rid of this cycle. When the patient has painful conditions such as migraine, they tend to manage it with the pain killers. Initially, the pain killers do their work due to the change in the concentration of neurotransmitters that can be managed by the body and normally perceived by the brain. Thus, the patient gets relief from the severe pain. This becomes a routine and the patient starts administering the analgesics at higher dose for a longer period. The problem began to start at this stage.

In this stage, the concentration of neurotransmitters starts altering in such a manner that the body does not able to tolerate this change due to high level of analgesics. Due to this phenomenon, the brain also has an abnormal perception for pain receptors and in spite of taking analgesic; the pain does not go away or even become worse. To manage this pain, the patient again takes analgesic resulting in the cycle of pain-analgesic-rebound headache-analgesic-rebound analgesic. This is known as rebound headache cycle. Various approaches are developed to break this cycle and these approaches provide positive results.


Headache cycle can be broken by completely eliminating the use of analgesics. The approaches used for breaking the headache cycle involve bridge therapy, prophylactic therapy and avoiding the use of opioids and barbiturates.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:October 16, 2019

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