Are you making your headaches worse?(5-MINUTE CONSULT)

MY PATIENT, a 38-year-old receptionist, sat down in my offce and began to cry. Although she had experienced migraines several times a year since herteens, for the past few months she had been suffering from headaches daily.

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Over-the-counter pain relievers were no longer effective and she was barely functioning at work. She had been taking up to three tablets of Advil (ibuprofen) or two tablets of Excedrin three times a day and often added Tylenol PM when she was unable to sleep.

Although she didn't realize it, she had made the problem worse. Her regular use of pain relievers had brought on a condition known as medication-overuse headache, which affects up to two-thirds of patients who seek help at headache treatment centers in the U.S.

The International Headache Society defines medication-overuse headaches as those that are present for at least 15 days a month or have developed or markedly worsened because the sufferer took too much medication.

The problem, previously known as "rebound headache," can be caused by prescription pain medications, over-the-counter pain relievers, or combinations of medications. Almost all such drugs have the potential to cause medication-overuse headaches; some experts believe the most common culprits to be preparations containing barbiturates (such as Fioricet and Fiorinal), opioids, acetaminophen, non-steroidal anti-inflammatory agents such as ibuprofen (Advil and generic) or naproxen (Aleve and generic), and migraine-specific drugs called triptans (such as Imitrex and Maxalt).

The ready availability of nonprescription pain relievers on drugstore shelves and in many homes might add to the problem. A recent CONSUMER REPORT survey of more than 6,000 subscribers confirmed that most of their medicine cabinets did contain over-the-counter pain-relief drugs including acetaminophen (73 percent), ibuprofen (73 percent), and aspirin (69 percent). In a more ...