What is the best treatment for analgesic rebound headaches?

Abstract

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).