New Daily Persistent Headache Support Group

I'm so puzzled and confounded by analgesic rebound / MOH.

There seems to be so many different opinions by researchers and clinicians. It's driving me crazy

Everyday I wake up with non-pulsatile head pain. By the time I have finished getting dressed and eating breakfast, I'm in pain from head to toe. This is probably from my Fibromyalgia. If I don't rest and Ice , I will get a migraine. If I do unless faced with another trigger, I can usually make it to the early afternoon before getting a migraine (pulsatile, usually right sided pain).

According to the Fibromyalgia docs, I should take Tylenol or NSAIDs when experiencing mild to moderate pain, even daily.

According to the Headache docs, this is a big no-no and cause of analgesic rebound headaches.

Anyone seen any definitive research on this topic?

I have not seen anything definitive, though I have read that pain meds taken for pain other than headaches (muscle sprain in the case of the study I saw) do not seem to lead to MOH for some reason (which the study did not attempt to explain).

The only problem with applying this to your case is that you ARE having headache and everything else ache all at the same time. I don't know what this would do. Since it is a common problem with fibro (and headache and fibro are frequent companions...NDPH maybe linked too, just judging from how many people are members of both groups here), I think I would do whatever the doctor most experienced with fibro tells you, but keep a good headache diary and if you realize you are rebounding be prepared to stop.

You are in one of those annoying conundrums caused by having two conditons with conflicting medical treatments. Not fun.

Sorry, but what is MOH?

Also, I am not sure if this relavant, but here's my contribution: I had surgery last week Wednesday on my shoulder. I had a migraine everyday since then, becoming increasingly worse as the week wore on. I was taking Darvocet for the pain. It greatly helped my shoulder but not my head. I tend to have bad reactions to medications and mixing them so I was afraid to mix my migraine abortive (Frova) with my Darvocet so I just toughed it out. By Sunday evening it was unbearable and took a Frova... it helped my migraine a lot and ever since I stopped taking the Darvocet (Sunday night was my last on) for my shoulder, no more migraine. Now if I had known that perhaps the darvocet was making my migraine worse/rebound, I would have toughed out the shoulder pain or taken tylenol or something instead. So to sum up, the Darvocet was either causing or making my headache worse. I'm not sure if you are reffering to something like this but since I don't have a constant headache, I thought I'd throw it out there.

Oh wait, if only I had read the title I would know what MOH stands for.... DUH! Forgive me as I'm still not all there.

Drmeows, how are you feeling now? I had shoulder surgery not fun.

Chill out you probably did not get medication overuse headache from the Darvocet. It's very unlikely that you got MOH from 1 week of meds. Were you taking pain killers for a while before the operation?

The culprit is probably the Anesthesia. When the Anesthesiologists inject the good stuff in you, the newer needles (which I assumed they used) are designed to push apart nerve fibers as opposed to puncturing them. Though it's still possible for a puncture.

I would call up the Anesthesiologist and ask her/him if your migraines could be from the anesthesia. Mine actually called me at home the next day after both my knee and shoulder operations. Some of my friends hadn't even called. Can you imagine?

I pray for your speedy recovery.

Very not fun. I am doing much better now, but I had a solid 5 days of a lot of pain. I really felt like my surgeon kicked my shoulder for an hour with some big boots on or something. I saw him for a follow up yesterday, he encouraged me to start moving it all around and it actually feels better now that I am moving it around instead of protecting it from everything.

I've had dr's and surgeons in the past call to see how I was doing. Those doctors are a rare gift! I almost got a migraine today but I was able to negate it by going to bed and then just chilling. So far it hasn't blown up and I am walking on egg shells till I go to bed. Maybe my body misses all the running and working out it's used to! I was thinking about what you said, however, the anesthesiologist only poked me in my hand where he put the IV, is that what you were thinking could have caused these headaches?

I went to the chiropractor today (he only worked on my neck since I cannot lay face down) and so hopefully tomorrow I will feel much better, it's been very tight and painful with all the head pain. I'm not used to laying around and sleeping so much so perhaps that is a contributor to all these headaches too. I have to tell you, I get really paranoid when I have a headache that continues longer than a day. If Ryan and I both had a constant one, we'd be screwed.

Thanks for the prayers MJ! Hope you're having a good day today.

Apparently pure opiates (such as Tramadol which apparently is recommended for Fibro too) are better than Tylenol/analgesics. I suspect I had MOH in the past with Tylenol, but have suspected no issues once I started daily opiates for pain management for my NDPH. I keep a close eye on my actual pain type and levels.

Aleve is also less likely to cause MOH than Tylenol. I think its case by case, so you may want to try to see if the medications can ease your pain. Even with MOH, if you ended up with less pain that before and it improves your quality of live, would it matter to you? Sometimes I think there is too much focus on MOH and not enough on improving the quality of life of 24/7 headache patients.

This is just my opinion. I would talk to your doctors and see what you think. Worse case scenario you medicate your pain, get MOH which increases your pain, stop the pain medication for a few weeks, and are back where you started. I'd give it a shot! I am so glad after years I finally gave pain management a try. Already I am having a huge improvement, for me, about 30-40% pain relief. It makes a big difference for me.

Feel better drmeows! Your body has just been through a trauma so no wonder you are having headaches. I am sure that they will remit once your shoulder settles a bit. Sorry that you had to have surgery. Take good care.

You're right drmeows I was thinking about an epidural. I hope you are feeling better.

wishing you a speedy recovery,

MJ