It sounds as though Janet may be suffering from medication overuse headache (MOH) – sometimes known as rebound headaches. The National Institute for Health and Care Excellence (NICE) states in its clinical guidance on the diagnosis and management of headaches in the over 12s that healthcare professionals should “be alert to the possibility” of the condition “in people whose headache developed or worsened while they were taking the following drugs for three months or more: triptans, opioids, ergots or combination analgesic medications on 10 days per month or more, or paracetamol, aspirin or an NSAID, either alone or in any combination, on 15 days per month or more”.

The mainstay of treatment of MOH is withdrawal of the overused drug(s). While some medications need decreasing before stopping them altogether, this is not the case for drugs such as triptans and simple analgesics, which can be stopped abruptly and should be avoided for at least a month. The condition should be explained to Janet, and she should also be told that her symptoms may initially worsen before improving. She should be advised to persevere and ask for support if she needs it. Staying well hydrated, exercising and practicing relaxation techniques may all help.