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Medication Overuse in Chronic Headache Sufferers

Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

As many as 50% to 80% of chronic daily headache sufferers say they use painkillers frequently — which, paradoxically, actually makes their headaches worse. This common problem, known as medication overuse headache, can occur with overuse of any headache medication, but caffeine-containing drugs (see Table) are most often to blame. Contrary to popular belief, caffeine has long-lasting effects and stays in your system for two to three days. If you take caffeine-containing medications more than two to three times a week, the vasoconstricting effect builds up. But when the caffeine wears off, you experience vasodilation, which reignites your headache — an effect similar to a "weekend headache". The phenomenon, also known as a drug rebound headache, is less prevalent with triptan drugs because they don't stay in your system as long — usually only 12 hours or so.

In addition to the rebound vasodilation, experts also speculate that regular use of analgesics interferes with the body's natural painkilling system. Because painkillers mask symptoms, whatever is causing the pain may worsen. As the pain becomes more intense, painkillers are less able to control it.

People with medication-induced chronic daily headache may experience severe pain upon awakening, which then lessens as the day goes on — the exact reverse of the pattern most often seen in chronic daily headache. Such severe morning headaches probably result because any medication taken during the day has worn off during the night. The pain then subsides during the day as additional medication is taken.

Table: Caffeine content of some common headache drugs

Caffeine is a double-edged sword when it comes to headache drugs. While this popular stimulant helps painkillers work more quickly and efficiently, it is often a suspect in medication overuse headaches. (Note: For reference, the caffeine content in a cup of coffee ranges from 95 to 200 milligrams.)

Drug name

Caffeine content (mg)

Over-the-counter drugs

Anacin Advanced Headache Formula


Excedrin Migraine


Goody's Extra Strength Headache Powders


Midol Complete Caplets


Vanquish Extra-Strength Pain Reliever Caplets


Prescription drugs (Brand name)

Ergotamine/caffeine tablets (Cafergot)


Ergotamine/caffeine suppositories (Migergot)


Aspirin, butalbital, caffeine (Fiorinal)


Acetaminophen, butalbital, caffeine (Fioricet)


Aspirin, caffeine, orphenadrine (Norgesic, Norgesic Forte)

30, 60

Aspirin, caffeine, dihydrocodeine (Synalgos-DC)


Last Annual Review Date: 2011-01-01T00:00:00-07:00 Copyright: Copyright Harvard Health Publications

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Prescription painkillers, also known as opioids, are responsible for almost 3 in 4 prescription drug overdoses.