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Headaches Associated with Substances or their Withdrawal

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Rebound headache due to regular painkiller use, especially morphine-related drugs and combination remedies which contain aspirin +caffeine or opiate+paracetamol: episodic headaches (tension or migraine) may become, for example, "transformed migraine": a daily headache.

Daily intake of medication for tension headaches may in fact worsen the headache and make it less responsive to preventive medicines.

Over 1000mg (1g) of aspirin or paracetamol for more than 5 days per week for at least one month may precipitate rebound headaches.

For compound analgesia, over 3 tablets per day for more than 3 days a week over one month may also cause the problem.

In other words: this sort of use of painkillers (many of which are available over-the-counter) can change episodic tension-type (or migraine) headache into chronic daily headache or worsen chronic tension headache.

WITHDRAWAL from caffeine or excessive intake

Oral contraceptives/HRT>> migraine

Foods containing nitrites (see above) MSG, tyramine and aspartame (artificial sweetener)

Excessive intake of benzodiazepines (diazepam, temazepam etc.)

Blood pressure medication

Heart medication: GTN, isosorbide,

Ergotamine preparations: used to prevent migraines: if used in excess (should only be given twice a month maximum) or occasionally, in unlicensed use, 1mg at night for 6 nights in 7 to manage cluster headaches or daily for 1-2 weeks may be given.

Smoking: studies have shown that smokers may experience greater weekly peak headache intensity. However, others suggest that there is no significant association.

Alcohol is known to be associated with triggering cluster headaches.