Q. I have had chronic daily headaches and migraines with aura for years. I also have fibromyalgia, TMJ (temporomandibular joint syndrome) disorder and irritable bowel syndrome (IBS). All of these involve chronic pain. I take Relpax® for the migraines, which helps a lot with the aura and works okay for the headache. I also take Cymbalta® for depression, but haven’t noticed any pain relief from it. The only other medication I seem to tolerate is Advil®. Since I have a headache “24-7”, with no beginning or ending, I never really know what causes it. How many pain relievers (like Advil) do you have to take to get a rebound headache? I never take more than two a day, but I wonder if taking them for several days makes my headache worse. I want to do anything I can to prevent an already difficult situation from getting worse.
A. Chronic daily headaches are commonly associated with fibromyalgia, TMJ, IBS and other chronic pain disorders. The treatment for all those disorders is even similar. However, there is always a risk that overuse of pain medications will cause rebound headache, tolerance (a need for higher and more frequent dosing) and/or dependency. Opioid-type analgesics, caffeinated products, barbiturates, triptans and ergots are known to be the main cause of rebound headaches. There is a debate as to whether nonsteroidal anti-inflammatory medications (such as Advil and Aleve®) may also be responsible. I think that you should seek help from a headache clinic, where these issues can be addressed.

George Urban, M.D.
Diamond Headache Clinic
Chicago, IL