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REPLY:
Dear Alan,
I’m sorry, but this isn’t a question, it’s several appointments with a good Migraine specialist. Answering this one would take hours and page after page, but we’re glad to at least get you started. As you probably already know, stopping rebound is accomplished only by stopping the use of the medication(s) causing the rebound. Early in rebound, some people are successful with stopping the offending medication “cold turkey.” Others need hospitalization for IV therapy. Depending on the person and the medications involved, completely overcoming rebound can take from days to months. Until rebound is stopped, it is doubtful that any Migraine preventive medications will be successful. Many patients find that, once free of rebound, both preventive and abortive medications that they tried unsuccessfully during rebound can then provide good results.

Regarding which abortives are best to prevent more rebounding: The key is to find a preventive regimen that successfully keeps the number of Migraine episodes low enough that you don’t need abortives often enough to risk rebound. Medications that are considered abortives include Midrin, ergotamines, and triptans. Midrin shouldn’t be used more than two days a week because it contains acetaminophen, a prime rebound culprit. Ergotamines have long been known to cause rebound, and their use should be limited to two or three days a week, depending on your doctor’s advice. Triptan rebound has been questioned, but there are now some studies demonstrating that triptans can induce rebound headaches for some patients. It’s recommended that their use be limited to two or three days a week also. Specialists do NOT recommend alternating triptans and ergotamines to prevent rebound as they act on the same receptors. Thus, use of triptans and ergotamines should be no more than two or three days a week total.

Your best course of action to stop rebound and get effective preventive and abortive regimens in place is to see a reputable headache and Migraine specialist.

Teri Robert
(answer reviewed by Dr. Krusz)

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