How To Deal With Rebound Headaches After Surgery?

Surgery in the patients with migraine poses a serious challenge in managing the symptoms of pain. This is due to the fact that administering analgesics to such patients may increase the risk of rebound headache.

How To Deal With Rebound Headaches After Surgery?

How To Deal With Rebound Headaches After Surgery?

Dealing with pain after surgery is a difficult task for the patient who is already on the other pain relieving medication for migraine and is at higher risk of rebound headache. This means the administration of analgesics which may further complicate the headache. The best way to manage the rebound headache is to completely avoid the analgesics but in case of pain after surgery, the patient has to take the analgesics. Thus, following conditions should be followed in order to reduce the risk of rebound headaches that may occur due to the analgesics for post-surgical pain in migraine patients:

  1. Single Ingredient Analgesic: Single ingredient analgesics have relatively lesser risk of causing the rebound headache as compared to multiple ingredient analgesics. Thus, the physician should prescribe the analgesics which contain only a single ingredient.
  2. Low Risk Of Rebound Headache: There are some drugs which have the high risk of causing rebound headache and there are other drugs which have low risk of rebound headache. The patient should take the analgesic of the latter category. The analgesics which are high risk of causing rebound headache are aspirin and opioids while the analgesic with low risk is naproxen.
  3. Dose Adherence: Most of the cases of rebound headaches are due to the administration of higher than prescribed dose. The patient, in order to get relief from the pain immediately, takes the higher dose resulting in rebound headache. Thus, the patient should adhere to the dose of analgesic as prescribed and if the symptoms does not subside, may take advise from the physician.
  4. Duration Adherence: The risk of rebound headache also depends upon the duration of administration of analgesics. The longer the usage of analgesics, the more the risk of rebound headache. Thus, the patient should take the medicine up to the time it is prescribed.

Rebound Headache

Rebound headache is caused when the pain killers or analgesics are taken for a longer period in conditions such as migraine. The condition is developed due to a normal perception of brain for the pain signals due to change in concentration of neurotransmitters. The symptoms of the rebound headache may include depression, dizziness, nausea, irritability, cognitive dysfunction and fatigue. The rebound headache is characterized by the presence of unilateral pain which is constant and dull. Sometimes the pain due to rebound headache is severe. The condition is caused when the patient does not follow the instruction of the physician on the following grounds:

  1. Dose: Most of the patients think that higher dose may cause this pain to subside earlier as compared to low dose. Due to this, the patient took the dose higher than prescribed leading to medication overuse headache.
  2. Duration: Most of over the counter drugs are at higher risk of causing rebound headache due to their prolonged administration. Thus, the empirical treatment of the headache should not be more than the prescribed period as this may lead to rebound headache. If the drug is required for frequent use, rationale therapy should be done.

Rebound Headache Causes

Rebound headache is a complex phenomenon as the drugs used to deal with a symptom itself increases the same symptoms. It is interested to note that the analgesics prescribed to deal with the pain themselves causing the pain. It is due to the headache cycle which moves as pain-analgesic-rebound headache-analgesic and the system goes in a non-ending cycle. This cycle is known as rebound headache cycle. When the initial dose of the analgesic is given, the level of the neurotransmitter alters in the range manageable by the body and the brain and the patient gets relief from pain. However, as the dose and the duration are increased, the level of chemicals in the body alters to such an extent that the body is not able to manage leading to further pain.


Surgical pain management in migraine patients is a challenging task as they are already on the pain management system and adding more analgesics to their regimen increases risk of rebound headache. However, the approaches used for managing pain in such patients are using single ingredient analgesics with low risk of headache and adherence to dose and duration as prescribed.

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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:December 27, 2018

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