Why Does Benzodiazepine Withdrawal Cause Head Pressure, and What Helps?

Key Takeaways

• Head pressure during a benzodiazepine taper comes from a nervous system adjusting to less medication, and the first thing to look at is the pace of the taper.
• Tense muscles at the back of the neck, the scalp, and the forehead are part of it, which is why the pressure often feels like a tight band around the head.
• During a taper, head pressure is almost always a symptom of adjustment and not a sign that the brain is being injured.
• When it flares after a reduction, one response is a short hold or smaller steps agreed with the prescriber, though some people do better keeping a steady pace.
• Never stop the medication suddenly or rush the taper to get it over with, because that can cause withdrawal reactions, including seizures, that can be life-threatening.
• On a bad day, rest, a warm or cold pack, stretching, a short walk, and enough water can take the edge off, although they do not fix the cause.
• Not every headache during a taper is withdrawal, so call 911 for a sudden, severe headache, weakness or numbness on one side, sudden trouble speaking or seeing, or a seizure.

What does head pressure feel like during benzodiazepine withdrawal?

Head pressure is one of the more common symptoms of benzodiazepine withdrawal, and one of the more frightening. People describe a tight band around the head, a feeling of fullness, or a weight pressing on the forehead, the temples, or the back of the skull.

It often arrives with dizziness, lightheadedness, and trouble concentrating. It tends to flare after a dose reduction, and it can come and go through a long stretch of a taper.

A person who feels this for the first time usually fears that something inside the head is being harmed. In most cases during a taper, that is not what is happening. Head pressure is a symptom of a nervous system adjusting to less medication, and the pace of the taper is the first thing to look at with the prescriber.

Why does a dose reduction cause pressure in the head?

Benzodiazepines work by enhancing the action of gamma-aminobutyric acid (GABA), the brain’s main calming chemical. In the first chapter of the Ashton Manual, Professor C. Heather Ashton explained that with long-term use the receptors become less responsive. The nervous system has reset itself around the drug.

That reset is physical dependence, and dependence is not addiction. In fact, the United States Food and Drug Administration (FDA) stated in its 2020 boxed-warning update that physical dependence can develop when a benzodiazepine is taken steadily for several days to weeks, even as prescribed.

When the dose comes down, the calming signal falls below what the nervous system is set for. In Chapter III of the Manual, Professor Ashton described what follows when the drug is removed rapidly: the excitatory mechanisms of the nervous system go into overdrive, and the brain and the nerves stay in a hyperexcitable state until new adaptations develop. A dose cut that is larger than the nervous system can absorb appears to do the same thing on a smaller scale.

Muscles are part of it. Benzodiazepines are muscle relaxants, and the same chapter describes a rebound increase in muscle tension when they are withdrawn. Professor Ashton wrote that withdrawal headaches are usually of the tension type, caused by contraction of the muscles at the back of the neck, the scalp, and the forehead, and often described as a “tight band around the head.”

The symptoms that travel with head pressure are in the Manual too. Table 1 of Chapter III lists headache, dizziness, lightheadedness, poor balance, and poor memory and concentration among the symptoms of withdrawal, and the article on vertigo in benzodiazepine withdrawal covers the dizziness in more detail. Why one person feels a band and another feels fullness is not known.

Is head pressure a sign of brain damage?

During a taper, head pressure is almost always a symptom of adjustment. It is not a sign that the taper is injuring the brain.

Think of walking out of a dark movie theater into the afternoon sun. The light hurts, and for a minute it is hard to see. Yet, the sun is not damaging the eyes. They are set for a darker room, and they need time to reset.

A nervous system that is set for a higher dose needs the same thing. The article on what happens in the brain during benzodiazepine withdrawal explains that readjustment, and why it does not mean the brain is broken. Still, withdrawal does not protect anyone from the other causes of a headache, and the warning signs further down this page apply to every reader.

Fortunately, the first response is a slower taper or a hold.

When head pressure flares after a reduction, the likely message is that the cut was too large or came too soon. One response is a short hold at the current dose, agreed with the prescriber, though everybody is different, and some patients do better continuing at a steady pace than waiting out a long hold, with the medication never stopped suddenly. Then, the taper continues with smaller steps, more time between them, or both.

The Ashton Manual is the reference for gradual reduction. In Chapter III, Professor Ashton stressed that withdrawal symptoms can be minimized, and largely avoided, by slow tapering tailored to the individual.

In Chapter II, she described reductions of up to one tenth of the dose at each step, and she noted that many people take a year or more. She also wrote that the patient must be in control and proceed at a comfortable pace. The pace belongs to the patient.

The Maudsley Deprescribing Guidelines add that reductions should be hyperbolic, which means that each cut gets smaller as the dose gets lower. A step that was easy at a high dose can be too much near the bottom.

What if a cut proves too large? Professor Ashton preferred a hold to going back up. Still, a small step back up is a legitimate choice to make with the prescriber.

Unfortunately, the instinct to stop, or to rush and get it over with, makes things worse. The FDA’s 2020 update warns that stopping a benzodiazepine abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, that can be life-threatening.

What helps with head pressure on a bad day?

Comfort measures do not fix the cause, but they can take the edge off. For muscle symptoms, Chapter III of the Manual mentions stretching, moderate exercise, hot baths, massage, and relaxation exercises. Professor Ashton wrote that these may give only temporary relief at first, and that normal muscle tone eventually returns on its own.

People also report that rest, a warm or cold pack on the neck or forehead, and gentle movement such as a short walk make a bad day easier. Drinking enough water matters, because dehydration causes a headache of its own. The Manual adds that there is no need to drink extra fluid to flush anything out.

Professor Ashton considered coffee or tea in moderation compatible with withdrawal, except for people who are very sensitive to caffeine or whose anxiety is very high. Yet, some people find that caffeine tightens the band, and they feel better after cutting back.

What about a pain reliever? Professor Ashton wrote that there is no need to avoid ordinary painkillers for everyday aches and pains, although the prescriber or a pharmacist should confirm the choice.

The evidence behind all of these is limited, and response varies from person to person. They are choices to weigh with a physician who understands the pharmacology. None of them takes the place of a gradual taper.

When is head pressure an emergency?

Not every headache during a taper is withdrawal. Call 911 or go to the nearest emergency room for any of the following:

• a sudden, severe headache, the kind people call the worst headache of their life
• weakness, numbness, or drooping on one side of the face or body
• sudden trouble speaking or understanding speech
• sudden loss of vision or sudden double vision
• a seizure
• a headache with a fever and a stiff neck, or after a blow to the head

A headache that is new, that keeps getting worse, or that feels different from the usual pattern deserves a prompt visit with a physician, even when it is not an emergency. Withdrawal is often the explanation. It should never be the automatic one.

What else do patients ask about head pressure during a taper?

Can head pressure show up between doses of Xanax, before a taper has started?

Yes. Xanax (alprazolam) is short-acting, and a person who is dependent on it can slip into withdrawal as each dose wears off, a pattern called interdose withdrawal. Head pressure that builds at the same hours each day and eases after the next dose fits that pattern. In Chapter II, the Ashton Manual describes a crossover taper to diazepam (Valium), whose slow elimination allows a smooth, gradual fall in blood level, and that switch is made where it helps.

How long does head pressure last?

There is no fixed answer. It tends to come in waves, flaring after a reduction and easing as the nervous system catches up, and for some people it lingers for a time after the last dose. Professor Ashton wrote in Chapter III that a steady decline in symptoms almost invariably continues after withdrawal, though it can take a long time.

Is head pressure the same as high blood pressure?

No. Head pressure is a sensation, and blood pressure is a number measured with a cuff. A reading is the only way to know, and a high one is something to report to a physician. A severe headache with a very high reading belongs in the emergency room.

A taper needs room to slow down.

Dr. Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida. In his practice, a flare of head pressure is treated as information about pace. Often the answer is a short hold or a smaller step, though some patients do better keeping a steady pace, and the patient decides when to move again.

The taper is planned over months, sometimes longer, and there is no deadline. A hold is not a failure. Fortunately, with time and a pace the nervous system can follow, head pressure tends to ease.

Dr. Leeds’ practice offers medically supervised benzodiazepine tapering to patients in Florida. Contact the office to ask about a taper that leaves room to slow down.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.