Rebound headaches result from prolonged repeated use of abortive headache medications.  These patients often suffer daily or almost daily symptoms.  Often times over-the counter analgesics are the culprit medication; however, most abortive prescription headache remedies share this potential if overused.  Characteristically, these headaches are described as nonthrobbing, global, and dull in intensity.  The pain is usually present upon awakening.

     The first step in therapy is to explain carefully to the patient that the medication they are taking to relieve the headache is what causes their symptoms the following day and that a period of several days to weeks of abstinence is required before symptoms abate.  When rebound headache is severe during this withdrawl phase, dihydroergotamine may be used for relief.  This medication may be administered as 1 mg per subcutaneous injection.  Injections may be no more frequent than 2 hours apart and a maximum of only 2 injections may be used in a single 24-hour period.  Other options include prochlorperazine (10 mg slow IV push) or intramuscular droperidol (2.5 mg).

     When rebound headaches are the result of butalbital containing analgesics, abrupt discontinuation of the medication may result in seizures.  Therefore, phenobarbital should be started upon discontinuation.  One protocol involves administering 50 tablets of 15 mg of phenobarbital to be taken as follows: 3 tablets QHS for 1 week, then 2 tablets QHS for 1 week, then 1 tablet QHS for 1 week, then 1 tablet QHS every other night until completion of the prescription.