In the clinic, there are often patients who ask: Why do I start taking painkillers for my migraine, but the more I take them, the more useless they are? This kind of patients tend to have migraine attacks more frequently, so they have to take painkillers when they have migraine attacks, and the effect is obvious after they start taking painkillers, but the headache will worsen once they don’t take them, and the dose of painkillers will become larger and larger, so the physical and psychological dependence on painkillers will be formed, and in the long run, the phenomenon that even if they take painkillers, the effect will become worse and worse, but the pain will be worse if they don’t take them will occur. We call it drug-dependent headache, or drug-abuse headache. Studies have concluded that painkillers have varying degrees of effect on the central nervous system. If painkillers are taken for a long period of time or in large quantities, they will gradually weaken the antinociceptive mechanism that exists in the central nervous system itself, and instead, pain allergy may occur. Once the patient stops using painkillers, various withdrawal phenomena will occur, such as insomnia, anxiety, general discomfort, gastrointestinal symptoms, etc. In this case, the patient may relieve the pain for a short time by increasing the dose or the number of times of taking medication, but a vicious cycle will be formed for a long time, and the headache will get heavier and heavier, and such patients are often in great pain, with poor quality of life and low work efficiency, which seriously affects life and work quality. Therefore, taking painkillers can be as addictive as smoking and drinking alcohol, and you should not abuse painkillers when you have a headache, which should be taken seriously by doctors and patients. What to do if you have a substance abuse headache First, the health care provider should follow up with the patient for at least 1 year over a long period of time and inform the patient that the migraine is not the result of underuse, but overuse. Advise the patient that pain medication used 2 to 3 days a week is too much and to learn how to use pain medication properly. Oral prophylactic medication is needed before withdrawal of pain medication because it often takes about 4 weeks for prophylactic medication to reach effective blood levels. Common prophylactic medications include: antiepileptic drugs such as topiramate, sodium valproate, gabapentin, and levetiracetam. Oral prophylactic medications are taken for 3 to 4 weeks before pain medications are tapered off. Some medications can be withdrawn immediately, such as acetaminophen-containing medications, ergotamines, and traptans, while others need to be withdrawn slowly, such as benzodiazepines and barbiturates. Patients need to be informed that withdrawal symptoms may occur during withdrawal, such as nausea, vomiting, sleep disturbance, panic, anxiety, rebound headache, etc., lasting for an average of 3-5 days, which can be treated with antiemetic, sedation, hydration, or even hormone therapy. In addition, biofeedback therapy, relaxation training, stress management, and cognitive behavioral therapy can be combined simultaneously. If the migraine pain attacks last more than 15 days per month, more than 4 hours each time, and this state has been more than 3 months, then the patient can be said to have chronic migraine; for chronic migraine, the use of local injection of botulinum toxin type A to treat migraine is safe and effective, and the US guidelines clearly state that botulinum toxin is effective and safe for treating chronic migraine and is the preferred recommended method.