Published October 12, 2020 By Adam Lowenstein

I had a discussion with a patient recently who was interested in finding relief from her headaches, and as usual, sent me a list of her medications along with her long history of migraines. In reviewing her medical history, I had to do a double-take… she listed Excedrin as her primary medication, and she takes it 3 times each day. That is a LOT of Excedrin, and what we would consider the definition of a medication overuse headache.

What is medication overuse headache, and why does it happen?

While the first part of that question is well defined, the second is a bit of a mystery. Medication overuse headache is a headache that gets relieved, or partially relieved with a given medication but consistently comes back as that medication wears off. Common medications that are found to have an association with medication overuse headache are acetaminophen and aspirin, and Excedrin and Excedrin Migraine are both medications that contain…acetaminophen AND aspirin. As such, Excedrin Migraine is one of the most common culprits when it comes to “mediation rebound,” also called medication overuse headaches. In case you are looking for validation, you can find a discussion of Excedrin’s medication overuse headache issues on their own website at

Another big cause of medication overuse headache are narcotics. This is a topic that we have covered extensively on our website, and I would ask that you review those discussions here. The reason for narcotics, acetaminophen, aspirin, Excedrin, and other drugs to cause rebound or medication overuse headaches is not entirely understood. It does seem unfair that these medications that are supposed to relieve a pain syndrome actually are causing it, but we think that in some way the brain’s pain management controls get hijacked by the repeated use of these meds. Somehow, Excedrin Migraine and narcotics, and even some other meds like triptans, WHEN OVERUSED, can re-wire the pain centers of the brain and create a situation where migraine pain is present whenever the medication is not taken – and this is a real disaster.

Medication overuse can be a difficult problem to fix, and often requires the help of a headache specialist. The reduced use of medications is a major advantage of migraine surgery, which helps address the anatomic causes of the migraine pain. By decompressing the nerves that are causing the migraine in the first place, the origin of the migraine is addressed rather than using medication to try and relieve the symptoms. For more information on migraine surgery, click here or call our Migraine Surgery Specialty Center at 805-969-9004.

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