What is the best treatment for analgesic rebound headaches?
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Abrupt discontinuation of the offending analgesic(s), and treating rebound headaches with dihydroergotamine (DHE) as needed, results in significant improvement for most patients (strength of recommendation [SOR]: C; based on case series). Amitriptyline does not affect the frequency or severity of rebound headaches, but it may improve quality of life (SOR: B, low-powered randomized controlled trial). Prednisone or naratriptan (Amerge) lessen acute withdrawal symptoms from analgesics and reduce the need for rescue medications during the first 6 days of treatment; however, they do not affect headache frequency or severity (SOR: B, low-quality randomized controlled trial).
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