Medication overuse headache can develop when you take acute headache medication on too many days, month after month. You may also hear it called rebound headache. It builds on a headache condition you already have, such as migraine or tension-type headache, and the number of headache days goes up.
The International Classification of Headache Disorders (ICHD-3), published by the International Headache Society, sets the limits in days per month. The number of pills on a given day does not change the count. When you estimate from memory, you remember the day you took three tablets and forget the single ibuprofen on Tuesday morning.
Doses and stopping a medication are topics for your doctor. Counting is something you can start today.
The thresholds: 10 and 15 days a month
ICHD-3 describes medication overuse headache with three conditions. You have headache on 15 or more days a month, you had a headache disorder before, and for more than three months you have taken acute medication regularly on more days than the threshold for that drug. The threshold depends on the drug class:
| Acute medication | Threshold |
|---|---|
| Triptans | 10 or more days a month |
| Ergotamines | 10 or more days a month |
| Opioids | 10 or more days a month |
| Combination analgesics (several active ingredients in one tablet) | 10 or more days a month |
| Several classes, none over its own threshold | 10 or more days a month in total |
| Acetaminophen (paracetamol) | 15 or more days a month |
| NSAIDs such as ibuprofen, aspirin or naproxen | 15 or more days a month |
Your doctor makes the diagnosis. You use the table to place your own numbers and to walk into the appointment with precise questions.
Count days, then classes
For a clean monthly number, follow five fixed rules:
- Any day with at least one dose is a medication day. Three tablets on Monday still make one day.
- If you take two different drugs on the same day, that day counts once in each drug's column and once in the total.
- Write down painkillers you take for other reasons too, such as toothache or back pain. Your doctor decides whether they count toward your headache.
- Count by calendar month and stick with it, so you can compare one month with the next.
- Keep headache days in a separate column, including mild days without any medication.
Say you take ibuprofen on six days in March and a triptan on five other days. Ibuprofen stays below 15 and the triptan below 10. Together you reach eleven days with acute medication, and ICHD-3 sets 10 days as the threshold for that combined total. With a tally per drug class, you see it in March. With one rough guess for the whole month, you miss it.
At the end of each month, fill in four values:
- [ ] Headache days
- [ ] Medication days in total
- [ ] Medication days per drug
- [ ] Days the drug helped
You forget the easy days
At the appointment your doctor asks how many days you took something last month. You think of the bad attacks. The tablet you took as a precaution before a long meeting slips out of that count, and days like that push a total over a threshold.
A log you fill in at the moment you take a dose costs you a few seconds a day. Add whether the headache eased one to two hours later. After a few weeks you see which drug works for you and on which mild days you still reached for a pill. The full setup of a headache log is covered in the migraine and headache diary, and the details of a medication record in keeping a pain medication log. The basics are in how to keep a pain diary.
Counting with PainTrack
Add each acute drug under More → Medications with the type "As needed", plus name, dose and form. You log a dose on the Today page under "Medications today", or attach it to a pain entry with "+ Medication". If you switch it on, the app asks about the effect after one, two or four hours.
Every dose then appears in the Diary. With the "Doses" filter you see them grouped by day and can count the medication days of a month. On the Analysis page, the History chart shows doses as dots below the zero line, and the 30-day view covers one month at a glance.
- Free: one active medication, logging doses, medication reminders, the effect follow-up, and the last three months of doses visible.
- Pro: unlimited medications (a triptan plus ibuprofen already needs two), unlimited history, monthly reports with documented and pain-free days, and the PDF doctor's report with a medication list, doses per week and a timed list of doses.
The app does not compare your medication days with the thresholds and gives no alert at 10 or 15 days. You or your doctor make that comparison. Log headache-free days with a 0 as well, so your monthly report shows the days without pain.
Bring the numbers to your appointment
For the last three months, bring headache days and medication days per drug for each month. With those two rows your doctor can see whether a threshold is reached and since when. The sample report as a PDF shows what a finished summary looks like, and preparing for a pain appointment covers the rest of your preparation.
Talk to your doctor before you change anything about your medication. Your GP or primary care doctor can refer you to a neurologist or a headache clinic.
Call 911 in the US or 999 in the UK, or get seen right away, if a headache starts suddenly and severely, comes with fever and a stiff neck, brings weakness, trouble speaking or vision changes, or follows a head injury.
Frequently asked questions
How many days of painkillers cause medication overuse headache? ICHD-3 counts days, not pills. The threshold is 10 days a month for triptans, ergotamines, opioids and combination analgesics, and 15 days for acetaminophen and NSAIDs such as ibuprofen, each over more than three months.
Does ibuprofen for back pain count? Write it down either way. Your doctor looks at all your doses and decides whether it counts toward your headache.
How do I know if my headaches come from painkillers? A warning sign is a rising number of headache days over several months alongside many medication days. Only a medical assessment can confirm it, and your log gives your doctor the numbers for it.
Do I need to log days without a headache? Yes. Without those days you cannot show how many headache days a month had, and your distance from the threshold stays a guess.
PainTrack is not a medical device and does not replace medical diagnosis or treatment. The app is intended for personal documentation and self-observation.