Medication overuse headache: how many days is too many, and what to do

If you are reaching for painkillers more and more, and your headaches seem to come back more often, this guide is for you. That pattern has a name, it is common, and it can be treated. The first step today is simple: start counting the days you have a headache and the days you take medicine. Then book a chat with your GP or doctor before you change anything.

What is medication overuse headache?

Medication overuse headache is a headache caused by taking acute headache medicine too often. It used to be called “rebound headache”, and you may also see “drug-induced headache”. The International Headache Society lists these as “previously used terms” in its classification, ICHD-3.

It happens in people who already have a headache condition, most often migraine or tension-type headache. The Migraine Trust explains the cycle well: “pain returns as each dose of medicine wears off”. So you take another dose, and over time the medicine starts to cause more pain than it treats.

None of this means you did something wrong. The American Migraine Foundation puts it kindly: “Doctors understand that you are taking pain medication for a good reason.” If you are not sure what kind of headaches you have to begin with, our guide to migraine vs headache can help you describe them.

How many days can I take painkillers for a headache?

Doctors use day counts, not pill counts. ICHD-3 describes medication overuse headache as headache on “15 or more days/month in a patient with a pre-existing primary headache”, caused by regular overuse of headache medicine “for more than 3 months”. The overuse line depends on the type of medicine:

In each case ICHD-3 says the pattern lasts “for >3 months”. The UK guideline body NICE uses the same numbers. It tells doctors to be alert when headache “developed or worsened” while someone took “triptans, opioids, ergots or combination analgesic medications on 10 days per month or more” or “paracetamol, aspirin or an NSAID, either alone or in any combination, on 15 days per month or more” for 3 months or more.

Two details matter. First, ICHD-3 treats all simple painkillers as one group, so paracetamol on some days and ibuprofen on others add up together. Second, the American Migraine Foundation says painkillers taken “for non-headache pain also contribute to the risk”. ICHD-3 also notes the day limits “are based on expert opinion rather than on formal evidence”, so think of them as a guide your doctor uses, not a hard switch.

What are the symptoms of medication overuse headache?

The main sign is a headache on most days while you are taking headache medicine often. The Migraine Trust says “a dull constant headache is present on most days or a part of every day”, sometimes with migraine attacks on top.

Cleveland Clinic lists other common signs:

• headaches when you wake up or soon after waking
• headaches that get better with medicine but come back when it wears off
• medicines that seem to work less well than before
• nausea, tiredness, trouble concentrating or memory problems
• low mood, anxiety or panic

These signs overlap with other headache types, so only a doctor can say for sure. ICHD-3 also requires that the headache is “not better accounted for by another ICHD-3 diagnosis”.

How do you know? Count your days

From memory alone, it is hard to tell if you are just under a limit or over it. A simple diary answers it. For each day, write down:

1. Whether you had a headache, yes or no.
2. Which medicine you took, if any, and the dose.
3. Whether it helped.

At the end of each month, count two numbers: headache days and medicine days per type. Bring both to your appointment. NICE asks doctors to “consider using a headache diary”, and ICHD-3 says that when the picture is unclear, “this necessitates diary follow-up”. Our migraine diary guide has a free template and explains what else to note.

Marking headache-free days matters too. A blank day could mean “no headache” or “forgot to write”, and your doctor needs to know which.

How is medication overuse headache treated?

The good news first. ICHD-3 says “the majority of patients with this disorder improve after discontinuation of the overused medication”. Treatment means taking a break from the overused medicine, with your doctor’s help.

NICE gives doctors this guidance:

• Explain that medication overuse headache “is treated by withdrawing overused medication”.
• For overused acute headache medicines, advise people to stop them “for at least 1 month and to stop abruptly rather than gradually”.
• Warn that “headache symptoms are likely to get worse in the short term before they improve”, and give “close follow-up and support”.
• Consider a preventive treatment for the underlying headache condition at the same time.
• Review how things are going “4 to 8 weeks after the start of withdrawal”.

Opioids are handled differently. NICE points doctors to separate guidance on opioid withdrawal and suggests specialist referral for people “using strong opioids”. Cleveland Clinic says that with opioids or barbiturates, “your healthcare provider may slowly decrease your dose to prevent withdrawal”.

This is why the plan has to come from your doctor. The American Migraine Foundation is clear: “Always discuss with your doctor the most appropriate way to discontinue your medication since abruptly stopping specific medications can be dangerous.” Please do not stop or change any prescribed medicine, including a preventive or an opioid, without medical advice. Your doctor can also suggest other ways to get through bad days during the break.

How long does medication overuse headache last?

It usually clears once the overuse stops, though ICHD-3 says “usually, but not invariably”. Cleveland Clinic says: “Most people will see their rebound headaches fade and stop within two months. For more severe cases, it may take up to six months.”

Expect a harder stretch at the start. The Migraine Trust says “the most common withdrawal symptom is worsening of headache”, and others “may include nausea, poor sleep, restlessness, and stomach upset or diarrhoea”. Knowing this ahead of time helps, because a rough start is expected and does not mean the plan has failed. If you feel unsure, contact your doctor.

How Headache Pal can help

Headache Pal lets you log each headache with the medicines you took and whether they helped, and a daily “No headache” check-in so you can count headache days on the calendar. With Pro, the “What helps” view shows which medicines seem to work for you, and a doctor report PDF sums up the last 30 days for your appointment. The app is for iPhone only, it does not tell you how much medicine to take, and it is not medical advice, so ask your doctor about any changes.

How can I lower my risk?

The NHS gives a simple rule of thumb: “Try not to take painkillers for more than 2 days a week as this can cause you to get more headaches and make migraine harder to treat.” The Migraine Trust agrees, and adds that using painkillers “on extra days, on the occasional month or two” is safe.

Other steps that help:

• Keep counting your headache and medicine days, so you notice a rise early.
• If you need painkillers on more than 2 days a week, see your doctor. The American Migraine Foundation says you “would benefit from a visit with your doctor”.
• Ask whether a preventive treatment could suit you. Fewer attacks means fewer medicine days.
• Tell your doctor or pharmacist about every painkiller you take, including ones you buy yourself.

When to get medical help now

Medication overuse headache is not dangerous on its own, says Cleveland Clinic, but some headaches need urgent care. The NHS says to call 999 or go to A&E (in the US, call 911) if you have a headache and:

• it started suddenly and is extremely painful
• you have numbness or weakness in the body or face
• you find it hard to speak, balance, walk or remember things
• you are drowsy or confused
• you have loss of vision
• you have had a seizure (fit)
• you have had a head injury within the last 3 months
• you have a very high temperature, a stiff neck, or bright light bothers you
• you have a rash that does not fade when a glass is rolled over it

Ask for an urgent GP appointment or contact NHS 111 if a headache comes with vision or eye problems, vomiting, jaw pain when eating or a tender scalp, or is set off or made worse by coughing, sneezing, bending down or exercise. For everything else, a normal GP visit is the right next step, especially if “you regularly get headaches”.