Medication overuse headache is a frequent or daily headache caused by taking painkillers or migraine medicines too often. It develops in people who already have a headache problem, usually migraine or tension-type headache, and who take acute treatment on 10 to 15 or more days a month. It usually improves once the overused medicine is stopped, which is best planned with your GP or pharmacist.
Also known as rebound headache, painkiller headache, MOH
Symptoms
- Headache on 15 or more days a month
- Headache that is often there on waking
- A dull, pressing ache, or headaches that feel like your usual migraine but come more often
- Relief from painkillers that wears off quickly, with the headache returning
- Needing painkillers more often than you used to
- Neck ache, tiredness, poor sleep or difficulty concentrating alongside the headaches
Causes and risk factors
- Taking triptans, opioids such as codeine, or combination painkillers on 10 or more days a month for over 3 months
- Taking paracetamol, aspirin or anti-inflammatories such as ibuprofen on 15 or more days a month for over 3 months
- Having migraine or tension-type headache in the first place
- Taking regular painkillers for another problem, such as back pain, if you are prone to headaches
- Medicines containing codeine or other opioids, which carry a higher risk
- Anxiety or low mood, which are linked to a higher risk
What the evidence says helps
- Stopping the overused medicine is the central step. NICE advises stopping it abruptly rather than gradually, and staying off it for at least a month.2
- Headaches often get worse for a short time before they improve, so it helps to plan the timing and agree it with your GP.2
- European guidance says that for people overusing simple painkillers or triptans, clear advice and support to cut down can be enough. People overusing opioids need a slower, supervised reduction.3
- In a trial comparing three approaches, all three helped, and stopping the medicine while starting a preventive treatment gave the best chance of the headache resolving.4
- Most people improve. Success rates of around 50 to 70 per cent are reported, and education and follow-up reduce the chance of slipping back.1
Things you can try at home
- Keep a diary of headache days and every dose of pain relief you take, including over-the-counter products
- Speak to your GP or pharmacist before stopping, especially if you take codeine, other opioids or prescribed medicines
- Choose a quieter couple of weeks to stop, and tell family or colleagues what to expect
- Once things settle, agree with your GP how often you can use acute medicines, keeping well under 10 days a month
- Keep meals, fluids, sleep and activity as regular as you can
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A sudden, severe headache that reaches its peak within a minute (thunderclap headache): call 999
- Headache with a fever, stiff neck, a rash, confusion or drowsiness: call 999
- Headache with weakness, numbness, slurred speech, a drooping face or loss of vision: call 999
- A new or worsening headache after a head injury: go to A&E or call NHS 111
- A new headache over the age of 50 with scalp tenderness or jaw pain when chewing: see a GP the same day
- A headache that keeps getting worse, or is worse lying down, coughing or straining: see your GP urgently
How Apollo can help
Medication overuse headache is managed with your GP or pharmacist, and we work alongside that plan. We assess your neck, jaw and upper back for anything contributing to the underlying tension-type or neck-related headache, and use exercise, advice on activity and sleep, and hands-on treatment where appropriate, so that you have options other than tablets. If your history suggests medication overuse, we will explain why and encourage you to speak to your GP before changing any medicines.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How do I know if painkillers are causing my headaches?
Suspect it if you have a headache on 15 or more days a month and have been taking pain relief on 10 to 15 or more days a month for over three months. A diary of headache days and doses makes the pattern much easier to see. Your GP can confirm the diagnosis.
How long does it take to improve after stopping?
Headaches commonly get worse for several days after stopping before they start to ease. NICE suggests a review four to eight weeks after starting withdrawal, by which time most people can tell whether it is working.
Which painkillers cause medication overuse headache?
Any acute headache medicine can, including paracetamol, ibuprofen, aspirin, triptans and codeine-based products. Triptans, opioids and combination painkillers can cause it at a lower number of days a month than simple painkillers.
References
- Diener HC, Holle D, Solbach K, Gaul C (2016). Medication-overuse headache: risk factors, pathophysiology and management. Nature Reviews Neurology 12:575-583. View source
- National Institute for Health and Care Excellence (2012, updated 2021). Headaches in over 12s: diagnosis and management. Clinical guideline CG150. View source
- Diener HC, et al. (2020). European Academy of Neurology guideline on the management of medication‐overuse headache. European Journal of Neurology 27:1102-1116. View source
- Carlsen LN, et al. (2020). Comparison of 3 Treatment Strategies for Medication Overuse Headache. JAMA Neurology 77:1069. View source
- (2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1-211. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
