Yeah, rebound seems to be really common with certain meds - Afrin has nasty rebound, and has nothing to do with migraines. Cholinergic rebound is a thing too…
I imagine the exact mechanisms are a bit different (since the drugs themselves are different and each has a different threshold for how often you can take it before you risk MOH), but the end result might be the same:
— Begin quote from ____
"A possible explanation of why migraine becomes chronic is that a yo-yo effect of repeated migrainous pain processes, followed by repeated medication, results in structural changes. These propagate central sensitization with a lowered threshold for activation of all of the central processing of head pain. "
— End quote
This one is a bit more technical, but basically says the same thing:
— Begin quote from ____
“Recent animal experiments have shown that chronic medication exposure profoundly affects the function of several areas in the nervous system related to headache pathogenesis. These changes include upregulation of calcitonin gene–related peptide, substance P, and nitric oxide synthase in trigeminal ganglia; expansion of receptive field and decreased nociceptive threshold of central trigeminal neurons; decrease in diffuse noxious inhibitory control; and increased susceptibility to develop cortical spreading depression (CSD). These changes indicate an increase in excitability of cortical and trigeminal neurons. The neuronal hyperexcitability may be the result of derangement of a central, possibly serotonin (5-HT)-dependent, modulating control system. Experiments with animals with low 5-HT showed that the processes of CSD and trigeminal nociception are enhanced in this condition. Derangement in the central 5-HT–dependent modulating system as a result of chronic medication use may underlie the chronification of headache as observed in patients with medication-overuse headache.”
— End quote
(link.springer.com/article/10.100 … 011-0234-y)
So basically, it appears repeated use of rescues or abortives start to chemically change our brains, reducing our trigger threshold, and thus increasing the frequency of migraines. Then it gets reaaaallly easy to get stuck in a loop of more headaches --> more meds --> even more headaches --> even more meds… and then you are in a REALLY bad place. At least that’s the vibe I get from these studies and other articles I have read. I could be interpreting them totally wrong.
As for pain management, I also have a massage cushion but due to allodynia find it way too intense during the worst of the migraine (great for in between though!). That said, I find gentle self massage just with my own hand to be really helpful. Sipping on warm, slightly sweetened chamomile tea is very soothing to me. It helps me calm a queasy stomach and allow me to relax a bit. With heat and cold, it’s not just about heat and cold for me - it’s about moist heat and cold. Using a wet washcloth seems to help me better than traditional dry heating pads or ice packs. Sometimes I respond to heat better, and sometimes to cold, depending on the headache - I haven’t quite figured that out yet. Also, if the temperature is too extreme, it can make things worse for me - warm and cool work better than hot and cold. Since everyone is different, it may take some experimenting.
Some people swear by lavender and/or peppermint oil applied to the temples - can’t vouch for that one myself, as I am way too odor sensitive to do it.