A Common Misunderstanding About Rebound Headaches


welcome to the migraine miracle moment

I'm your host dr. Josh Turk net I'm a

neurologist migraine specialist migraine

sufferer and author of the book the

migraine miracle in this podcast you'll

learn all about how to find your path to

migraine freedom without pills let's get


hey folks so in this episode of the

miracle moment I'm gonna once again

revisit the topic of rebound headaches

mainly to help clarify what I've

recently realized is a common source of

confusion on the subject and so just so

we're all on the same page before I

launch into this rebound headaches are

traditionally defined as headaches that

are caused by the medications that are

used to relieve a headache so when the

aboard of medications for migraines

actually end up causing you to have more

migraines and I think that understanding

the principle that I'm going to review

here is really fundamental to deciding

what the role of abortive medications

will be in your own my green miracle

plan I know that when I fully realize

this particular principle it completely

turned my own approach to medications on

its head and getting other folks to

really understand it has led to so many

breakthroughs including the incredible

success stories that we've shared with

you here but before I dig into that I do

have an announcement to make which is

that our next Kido blast is going to

start on June 2nd

so the Kido blast is our 30-day Kido

challenge for Migron heirs and you can

learn all about it at Kido for migraine

dot-com that's ket o fo our migraine

calm and if you're listening to this and

it's past the June 2nd start date you

can still go to that site and you'll

find the date of our next challenge as

we hold these regularly and you'll even

be able to take advantage of earlybird

prices so you get a discount if you sign

up more than a week in advance

alright so on to today's topic so the

reason that I decided that I needed to

do an episode to clarify this issue was

that I would periodically hear questions

from people in our community that seemed

to indicate a misconception about the

phenomenon of rebound and much of that

just comes from the way that rebound is

typically talked about in the medical

community so part of understanding this


accurately will for many people require

unlearning some things that they thought

were true or that they were told about

rebound so for example one of the

questions I might get was would be how

long until I'm out of rebound or someone

else may say I know my headaches aren't

rebound I haven't taken anything in a

week or I'm attaining two weeks and so

on and like I said these questions kind

of reflect or indicate a fundamental

misconception about the nature of a

board of medications and how they

contribute to rebound or what exactly we

mean when we talk about rebound

headaches and like I said this was a

misunderstanding that I also carried

around for many years and one that I

passed along it's something that seems

kind of silly and naive now in

retrospect but you know I did so and

others do so because that's just the way

it's typically talked about but I can't

stress enough just how important it is

to really and truly understand this

issue because it's impossible to make an

informed decision about how to approach

your own migraines and it leads to so

many people making decisions that end up


undermining their ultimate goals and

keep them from not only getting to

migraine freedom but to having

ever-escalating migraines and never

really knowing why so the big

misconception here about rebound is that

it's an all-or-nothing phenomenon so

that you're either in rebound or you're

out of rebound or put it another way

that the abortive medications you've

taken in the past either are or are not

contributing to your current headaches

so if you think about it in this way

then it makes sense to say that you're

either in or out of rebound right it's

either on or off and it would make sense

to ask how long it takes to get out of

rebound but that's totally the wrong way

to think about it so the much more

accurate and most importantly much more

useful way to understand it is that

every dose of medication that's taken to

relieve a headache renders you more

vulnerable to a future migraine for a

given period of time and that is the

fundamental point to wrap your head

around so once again every dose renders

us more vulnerable to a future migraine

for a certain period of time

furthermore if we take something again

for a migraine before that period of

vulnerability has worn off then our

vulnerability to a future migraine goes

up even further and lasts even longer

now we can get to a point where the

medications have ratcheted our

vulnerability so high that we end up

with a constant and unrelenting headache

that won't go away and this is what has

led to so much confusion because it's

this is the thing that usually gets

labeled as rebound this constant

unrelenting headache that won't go away

and is not touched by the medications

and so the terrible misconception this

has led to is that once you're out of

that particularly horrible state which

is sort of the end result of the drugs

that the abortive medications are no

longer an issue or that they're no

longer making you more vulnerable to a

future migraine and in retrospect you

know this whole all-or-nothing idea

seems naive because biological systems

just don't work that way but it's the

very idea that I carried around for

years and I know it's still the

prevailing one that's out there around

this issue and it's in my opinion over

major reason why chronic migraines are

such a big problem and incidentally this

is actually one of the most important

breakthroughs in our understanding of

the pain system in general over the past

decade or so that when we take pills or

medications for pain relief they can

help in the short run but they make us

vulnerable to pain in a long run so

there's an increasing effort now to only

use these as a short-term solution while

you're trying to find a longer-term

strategy that works because we know that

the medications that are used for pain

relief even though they can help in the

short run change the pain system in ways

that will make the underlying condition

worse over the long run if we don't

adopt a different strategy so let me

just give you an example of how this

phenomenon applies to migraine and I'll

just use some hypothetical numbers here

to help illustrate the concept so

imagine you know we're we have a

migraine we haven't taken anything for

or a migraine maybe ever before right

and we take our first aboard of

medication and so that meant that

medication may provide some relief it

may relieve it fully it may relieve it

partially but it will render us more

vulnerable to a future attack of a

migraine over the next let's say three

days now let's say that two days goes by

and the bee starts to come back we start

getting another another migraine and so

we take another dose and so we're still

kind of in that window of vulnerability

whereas before it made us vulnerable for

the next three days and now it's going

to make us more vulnerable for the next

six days and that vulnerability is even

greater than it was before so now we've

extended the period the window of

vulnerability and that the level of our

vulnerability is even higher now let's

say in those next six days maybe five

days later four days later whatever the

beast visits again and we have to take

another dose then let's say our

vulnerability is extended for 12 days

and we're rendered even more vulnerable

and you can see that we could ultimately

reach a point where our window of

vulnerability has been extended so long

and the level of our vulnerability is so

high that we're essentially left

essentially left with a chronic and

unrelenting headache and that's the

thing we've been talking about as

rebound but this is just the final

result of a process that was already in

place with the aboard of medications

rendering us more vulnerable with each

dose and for years I saw this sort of

thing happened time and again with

patients in my clinic where you know

with with what seems like hardly any

medication at all their headaches were

continuing to worsen over time and they

were inning-ending up and sort of the

worst stages of rebound but again I

didn't see it because I was also blinded

by this misconception of rebound as

being kind of an all-or-nothing

phenomenon and I was discounting the

role that the abortive medications were

playing in this process so again if we

understand it in this way we understand

that there's no such thing as being in

or out of rebound but rather there's

just how much any recent aboard of

medications we've taken are contributing

to our current vulnerability to a

migraine and it was once I understood

this concept

that I decided that I had to find

alternatives for migraine relief both

for myself and for the people I work

with alternatives besides drugs so that

they could become a last resort and I'm

so incredibly glad that I did so now

really wrap your brain around this

concept go back and listen to this

episode again if you need to this has

been such a key insight for so many

people and has helped so many get to

where they want to be and it's why those

who have experienced the most rapid and

dramatic transformations some of which

you've heard hear or read on the website

were those who decided that they were

just done with the board of medications

of course everybody has to apply this

information in a way that works for them

in a way that works for their specific

circumstance or situation but for many

just understanding this concept has been

a real lightbulb moment and helps to

explain so much about why things

continue to worsen over the years even

as they thought they were doing all the

right things they had this idea like so

many that if they just stayed under a

certain amount you know a couple of days

a week of taking medications or less

that the medications just couldn't be

contributing but of course that's really

just trying to avoid the absolute worst

case scenario that we talked about and

the better way of thinking about it is

that every single dose matters which

really just helps us to make much more

informed decisions about the role that

aboard of medications should play in our

treatment plan and that's what's really

most important to me is for folks to

have all the information and the right

information so much of what's out there

is myth and rumor which is a problem of

massive proportion now with the internet

also so much of what's out there about

pharmaceuticals it's coming directly

from the drug companies sometimes

disguised as a journal article or an

expert opinion so there's a strong bias

towards minimizing the downsides of

pharmaceuticals or even just sort of

overlooking them or not seeing them or

being blind to them and then kind

over emphasizing or over hyping the

upsides again that's human nature and a

predictable consequence of the system

that we currently have which prioritizes

drug treatments over pretty much

anything else all right so that's it for

this episode I hope you found it helpful

and useful and once again we're

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