You’re taking six or eight pills a day, five or six days a week. Then what happens is, the headache starts to occur every day. It starts to go from mild to more severe, and before you know it, the medications that you’re taking are not working any more. That’s a rebound headache.

But if you have just two or three headaches a month, and then a couple of days later you get a headache again, that’s not usually a rebound headache. That is called a recurrent headache. It sounds the same, but is a little different.

What goes on in the brain and blood vessels that causes such headaches?
ALAN M. RAPOPORT, MD: There’s been research on serotonin, a chemical that we all have in our brain. Raising the level of serotonin sometimes helps us a lot, in terms of getting rid of pain, or getting rid of depression, or helping us sleep a little better. One of the problems, we think, is that when people take too much pain medication, something happens to the serotonin levels so that the chemical isn’t that effective any more. Some research shows that serotonin levels are a little bit lower when you take too much pain medication, and then when you stop taking it and your headaches start getting better, they come up a bit.

What kind of painkillers are most likely to cause rebound headaches?
MITCHELL S.V. ELKIND, MD: Medications like ergotamines, barbiturates, as well as opiate narcotics like Percocet and codeine, especially, can commonly do it. But even things like aspirin and Tylenol-any pain medicine that’s taken on a regular basis can do this.

Do women suffer from rebound headaches more?
ALAN M. RAPOPORT, MD: Women suffer from headaches more than men, in general, other than for cluster headache. And that has a lot to do with fluctuating levels of estrogen. Before women start to have their periods, before the age of about 11-13, boys and girls have about the same amount of headaches.

But after girls start menstruating, in general there’s about three times as many women than men that have headaches. We’re talking mostly migraine. But there’s even a little bit more tension-type headache in women. And it’s people with migraine who also have tension-type headache that can get this rebound headache a lot.

How do we break the cycle?
ALAN M. RAPOPORT, MD: I’ll tell you how easy it is to do, and then Dr. Elkind will tell you why it doesn’t work too well. What you have to do is gradually come off the medication and, within a few weeks, you’re going to be much better.

MITCHELL S.V. ELKIND, MD: It’s a hard thing to do, as you can imagine, to tolerate the pain for even that short a period of time-a lot of people can’t do that. So I think you have to try to use other medications while they are coming off the acute pain medicines that they have been dependent on. So you try to use other medications that can help lessen the withdrawal type of symptoms that they get.