Analgesic-Rebound Headache: Overdiagnosed?

In a recent editorial, Dr Robert S. Kunkel raises serious questions about analgesic-rebound headache, and meets the issues with skeptical pragmatism:

"I certainly agree that analgesic-rebound headache due to combination-type analgesics and ergotamine tartate is a very significant problem that I see daily in my headache clinic. However, I am not convinced that the frequent use of small amounts of pain aspirin, acetaminophen, or an NSAID is very often a significant factor in the etiology of transforming an episodic headache into a chronic daily headache..."

"I feel we are mislabeling a lot of patients with chronic headache as analgesic-rebound headache simply because they take aspirin or ibuprofen once or twice a day. Hopefully, this condition will be better defined in the future as we learn more about the cause of pain in the head."

Kunkel RS. Analgesic-rebound headache: headache of the nineties. Headache Quarterly 1998;9:231-232.