Medication Overuse Headache Checker (Rebound Headache)

Medication overuse headache, often called rebound headache, happens when frequent use of the medicines that treat headache starts to make headaches more frequent. It’s common, easy to miss, and very treatable once you spot it. The limits are set in days a month, not pills, and they differ by medicine. Enter your days below to see where you stand.

Medication overuse headache limits by medicine

The International Classification of Headache Disorders (ICHD-3) sets these limits, counted as days a month for more than 3 months:

Medicine	Overuse at
Triptans (sumatriptan, rizatriptan and others)	10 or more days
Lasmiditan (Reyvow), going by its label	10 or more days
Ergots (ergotamine, DHE)	10 or more days
Opioids (codeine, tramadol and others)	10 or more days
Combination painkillers (with caffeine, codeine or butalbital)	10 or more days
Several kinds mixed, none over its own limit	10 or more days in total
Paracetamol (acetaminophen) or aspirin alone	15 or more days
NSAIDs (ibuprofen, naproxen and others)	15 or more days

For a diagnosis of medication overuse headache you also need headache on 15 or more days a month in someone who already had a headache disorder like migraine.

What about gepants?

Gepants (ubrogepant, rimegepant and zavegepant) came out after ICHD-3 was written, so they aren’t on its list. Studies so far haven’t shown them causing medication overuse headache, but long-term data are still limited. Rimegepant and atogepant are even used as preventives. The checker shows your gepant days but leaves them out of the count.

Lasmiditan (Reyvow) is different. It isn’t a gepant, and its label carries the same overuse warning as triptans and ergots: 10 or more days a month. The checker has its own lasmiditan row and counts it against that 10-day limit.

How medication overuse headache is treated

Treatment usually means two things: starting a preventive and, often, cutting back the overused medicine. In the MOTS trial, everyone started a preventive, and people who weren’t asked to cut back their acute medicine did about as well as those who were. That doesn’t apply to opioids or butalbital, and another trial (Carlsen et al., 2020) found that cutting back plus a preventive worked best, so talk through both routes with your doctor.

The 2026 AAN and American Headache Society guideline says a preventive should be offered to anyone with medication overuse, and suggests ones with evidence in this group first: a CGRP antibody, atogepant, Botox (onabotulinumtoxinA) or topiramate.

Opioids and butalbital aren’t recommended for migraine. The American Academy of Neurology’s Choosing Wisely advice is to use them only as a last resort, because better options exist and frequent use makes headaches worse. If you take them, don’t stop suddenly on your own. That can cause withdrawal, and with butalbital it can cause seizures, so always make a plan with your doctor first. For the full picture, read our clinical guide to medication overuse headache.

Frequently asked questions

How many days a week can I take ibuprofen for headache?

For ibuprofen and other NSAIDs, the ICHD-3 limit is 15 days a month. To stay under it, keep to about 3 days a week at most, and many headache specialists suggest 2. If you need it that often, it’s worth talking with your doctor about prevention.

How many triptans a month is too many?

The limit is counted in days, not doses. Taking a triptan on 10 or more days a month for more than 3 months counts as overuse.

What does a rebound headache feel like?

There isn’t one tell-tale feeling. The clue is the pattern: headaches becoming more frequent, often daily or near-daily, at the same time as you’re taking acute medicine more often. Many people notice a headache on waking that eases with their usual pill.

How long does medication overuse headache last after stopping?

Headaches often get worse for a few days to a couple of weeks after cutting back, then improve. Many people end up with fewer headache days than before over the following months.

Do gepants cause rebound headaches?

So far, there’s no sign that they do. Gepants came out after ICHD-3 was written, so they aren’t on its list. Studies so far haven’t shown them causing medication overuse headache, but long-term data are still limited.

More free migraine tools

• MIDAS CalculatorMigraine disability score from 5 questions about the last 3 months.
• HIT-6 CalculatorHeadache Impact Test score from 6 quick questions.
• Migraine Screening TestDo your headaches look like migraine? The 3-question ID Migraine.
• Chronic Migraine CalculatorEpisodic or chronic? Check your monthly headache days.
• Medication Overuse Headache CheckerRebound headache check against the ICHD-3 day limits.
• Preventive Response CalculatorPercent drop in migraine days, and is it a fair trial yet?
• Caffeine CalculatorTotal your daily caffeine and see where it lands for migraine.
• Visit Summary BuilderA one-page printable summary for your doctor or neurologist.

References

1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Section 8.2, Medication-overuse headache. Cephalalgia. 2018;38(1):1-211. PubMed
2. Schwedt TJ, Hentz JG, Sahai-Srivastava S, et al. Patient-centered treatment of chronic migraine with medication overuse: a prospective, randomized, pragmatic clinical trial. Neurology. 2022;98(14):e1409-e1421. (MOTS) PubMed
3. Carlsen LN, Munksgaard SB, Nielsen M, et al. Comparison of 3 treatment strategies for medication overuse headache: a randomized clinical trial. JAMA Neurol. 2020;77(9):1069-1078. doi:10.1001/jamaneurol.2020.1179
4. Potrebic S, Tanveer S, Becker WJ, et al. Pharmacologic treatment for migraine prevention in adults: practice guideline recommendations. Report of the AAN Guidelines Subcommittee and the American Headache Society. Neurology. 2026;107(7):e214881. doi:10.1212/WNL.0000000000214881
5. Langer-Gould AM, Anderson WE, Armstrong MJ, et al. The American Academy of Neurology’s top five Choosing Wisely recommendations. Neurology. 2013;81(11):1004-1011. PubMed
6. Reyvow (lasmiditan) prescribing information. Section 5.4, Medication overuse headache. Eli Lilly and Company. Drugs.com

This tool is for education and to help you talk with your doctor. It doesn’t diagnose anything and isn’t medical advice. Your answers stay in your browser and are never sent to Cerebral Torque.