I only use the Tramadol in the 100mg ER or 50 mg dosages. I try to limit taking it to 2 days max. Then I'll go to Alleve (naproxen) for 2 days, than to Tylenol for 2 , ibuprofen, than back to Tramadol. There is a phenomenon known as "rebound headaches" that occurs if you stay on one analgesic for any length of time. Your body begins to adjust and "need" the painkiller. When increased dosages are not received, headaches occur. That's how it was explained to me by my neurologist. I haven't really noticed any increases of mood swings, but then again I have them pretty consistently anyway. Cognitive impacts are difficult for me to assess, since I also have "brain fart" moments too often. Not funny, but if I don't try to find some humor in this somewhere I'll lose it altogether. Nothing really relieves my headache pain. The Botox injections have been the most promising that has happened in that regard in the past two years.