Introduction and question about rebound headaches

Hi all

This is my first post so I will fill you in on the background. I'm 46, married with no kids and have been having migraines since my early 20s. I don't get aura, and initially they were almost exclusively triggered by alcohol so it took several years for them to be diagnosed (I thought 2 days in bed, unable to keep even water down, was just a bad hangover!). I get 2 different types of migraine. The most common is in the left temple, really intense stabbing pain and once it starts I know it will only get worse and worse. During these I'm sensitive (but not excessively so) to light/noise and to perfumes. I also sometimes get a headache in the right temple which is always much duller, but which can go on for days - I'll go to sleep with it and wake up with it still there. These days I never vomit, although I feel nauseous with both types.

I gave up red wine totally about 20 years ago and these days drink alcohol infrequently (and little) as I often (but not always) get a migraine when I do. Now the trigger is more likely to be stress and/or missing a meal. I work from home but am in constant contact with an office in London (including a small team that reports to me) and I'm usually at my desk from 9am to 7pm, sometimes later, although I take the dog out for 30 mins at lunchtime.

I discovered years ago that triptans work like magic for me (first Imigran and now Zomig) and my usual pattern used to be to wake up around 4am knowing I was getting a migraine, but before it really hurt. I'd take a tablet, go back to sleep and then get up and get on with my life. Sometimes a migraine develops during the day (especially if I skipped a meal, or simply ate too late) but again the triptans work. Both the left and right pains respond to triptans altho I tend to wait much longer before taking them for a 'right' pain, since I tend to feel that these are not 'proper' migraines since they are not so incapacitating.

To start with I wasn't aware of any connection between migraines and my monthly cycle, but over the years this changed. I was on the combined pill for years, but then switched to the mini-pill because of migraines for several more years and finally, about 3 years ago, to the Mirena coil. That lasted 6 months because it made the migraines so bad! Since then I've not been using any hormonal contraception, and once back on a natural cycle found I often got a right-side headache just before my period. I've now been diagnosed (via a blood test) as 'probably' perimenopausal and currently haven't had a period for 3 months. Although it's varied over the years, until relatively recently my prescribed 12 Zomigs a month has usually been about right. In the past year or so, however, my migraines have been getting much, much worse and I've often had periods of a week or two when I'm taking them almost every day (mostly left side but some right), then just as I start talking to the doctor about rebound headaches, the attacks stops and it's back to one tablet every few days. I'm keeping a regular migraine diary again and in the past 27 days i've had only 10 days when i haven't had to take a Zomig. Bizarrely, 5 of these were consecutively when I was ill with a horrible flu-like virus that has now kept me off work for almost 3 weeks (unheard of for me). Since my husband is travelling overseas for work for several weeks at the moment I've come to stay with my parents which means I'm being looked after (and the dog is being walked!).

The virus is still here and my legs and brain feel like cotton wool. However, I'm increasingly worried that these are rebound headaches, so, since I'm already off work I decided I might as well try a break from the Zomigs at the same time. Yesterday I got a right side headache and didn't treat it. Today I spent the whole day in bed with the pain coming and going, before deciding I would take a couple of paracetamol (which I didn't expect to work) and get up for supper. Strangely, the pain has now eased (due to the paracetamol?? I have to admit to not having taken paracetamol for a migraine in years!) which has slightly negated my primary reason for contacting this forum.

Anyway, I have seen a number of posts from a few years back on here that suggested that if you are trying to combat rebound headaches you don't necessarily need to go 'cold turkey' but can take a tablet 2-3 times a week if the pain continues to be excruciating. Is this still considered the case? Can anyone share their experiences of breaking the cycle? And how can you tell if you are no longer getting rebound headaches rather than actual migraines? Having just done 24 hours without one when I would normally have taken one I don't want to undo all the good work by taking a tablet before I should. But nor do I want to suffer a migraine when I know just one Zomig will get rid of it! And do these sound like rebound headaches or does anyone think it's just hormonal - and if so, is this going to go on until the menopause?!

Thank you all for reading - it's wonderful to find a place to meet people who understand what it's like (although I have to say that having read some of the posts on here I do feel that my own problems are minor in comparison).

Hellz

Hi Hellz,

Welcome to Healing well. Sorry to hear you are having such a rough time.

To go cold turkey with meds and rebounds has its good and bad points. You really need support from your Neuro with this as it is difficult to maintain, but it is well worth it as you will save yourself so much suffering in the future!!

The rule of thumb for preventing rebound headaches is to take painkillers (this includes triptans) for 2 days in any one week. That means you can take the allowed dose for a 24 hour period on two days in a week and that gives relief for two days and you ride out the rest!!! This is hard to do but it gets rid of the muzzy heads that are endless and gives a better sense of well being.

The problems arise when you get a virus and need to take such as paracetamol for several days in order to keep you temperature down. For what it is worth my personal opinion is that you have to go with that soemtimes and resume the 2 days a week when the virus has gone. It seems to work for me personally, but not everyone will have the same experience.

My head is always very much worse with a virus.

Can I ask, do you see a Neurologist, and is he/she a Headache Specialist?? If not I would strongly urge you to find one, if you are in the UK you can email me and I can let you have the details of one in your area!

Hope this helps, take care

Ann

Thank you both. The support is so appreciated. Ann, I am in the uk so will mail you later when I've worked out how! I have a gp appointment tomorrow if I can get there.

It's now 19 hours since this started and it's been right back to bing unable to keep even water down. will post again when I'm up to it.

Hi all - an update

After 24 hours of debilitating pain and nausea the migraine eased this morning and I have to admit although a bit shaky (I'm still recovering from the virus too) my head does feel clearer than it has done for a while, further confirming that this was rebound. Violet Rose, thanks for sharing your story, it helped me see a way through when things were at there worst last night.

My GP agrees, and has also agreed to refer me to a neurologist specialising in headaches (thanks for the suggestion Ann!). She's going to refer me to the man who gave an inspiring lecture she attended on migraines & rebound headaches recently, and who also does research in this area. Fingers crossed he will be able to take me on (and SmurfyShadow, I'll ask him about PCOS, thanks). She also prescribed me some anti-nausea medication which she said might help (I don't have the name on me) and suggested I try 3x 300mg aspirin at the first sign of a migraine rather than Zomig for now. Any thoughts on either of these from anyone?

Separately, I'm going to look into Bowen Therapy, which other members of my family swear by for pretty much any physical ailment, and talk to a nutritionist, as well as taking steps to improve how I deal with work-related stress. Equally importantly I will be telling my boss about the rebound diagnosis and the fact that in future I may sometimes have to take a day or 2 off when I get migraines (it was refusing to 'give into them' and just taking Zomigs every time that got me into this situation in the first place). I will let you know what, if anything helps!

So I know that I will have to go through the horrors of yesterday again, but I do feel that I am a bit more in control than I was before - and finding this forum was a big part of this, so thank you all.