Painkillers 'are the cause' of millions of headaches

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Up to a million people in the UK have "completely preventable" severe headaches caused by taking too many painkillers, doctors have said.

They said some were trapped in a "vicious cycle" of taking pain relief, which then caused even more headaches.

The warning came as part of the National Institute for Health and Clinical Excellence's (NICE) first guidelines for treating headaches.

It is also recommending acupuncture in some circumstances.

Start Quote

This can end up getting into a vicious cycle where your headache gets worse, so you take more painkillers, so your headache gets worse and this just becomes worse and worse and worse”

End Quote Prof Martin Underwood Warwick Medical School

"Medication overuse headaches" feel the same as other common headaches or migraines.

There is no definitive UK data on the incidence of the condition, but studies in other countries suggest 1-2% of people are affected, while the World Health Organization says figures closer to 5% have been reported.

While painkillers would be many people's instant response, they could be making sufferers feel even worse.

Prof Martin Underwood, from Warwick Medical School, who led the NICE panel, said: "This can end up getting into a vicious cycle where your headache gets worse, so you take more painkillers, so your headache gets worse and this just becomes worse and worse and worse.

"It is such an easy thing to prevent."

'Tipping point'

Exactly how painkillers have this effect on the brain is unknown.

Most of the people affected are thought to have started with either everyday, tension-type headaches or migraines. The headaches then became worse as they treated themselves at home.

Main types of headache

  • Tension - the common "everyday" headache most people will experience at some point in their lives. In some cases people have tension headaches on most days of the month.
  • Migraine - severe headache that can last for several days. It gets worse with activity and often comes with nausea as well as sensitivity to light and sound.
  • Cluster - extremely severe pain around the eye and side of the face, also includes swelling and a red watery eye. Some people report eight attacks a day, which can last up to three hours.
  • Medication overuse - feels like a tension headache or a migraine, but is due to taking too many painkillers.
  • However, there are more than 200 types of headache.

Manjit Matharu, a consultant neurologist at the National Hospital for Neurology and Neurosurgery, said there was a tipping point at 10 to 15 days of using pain relief each month when the drugs became the issue.

He said: "This is a huge problem in the population. The figures in terms of the number of people who have medication overuse headache are one in 50, so that is approximately a million people who have headaches on a daily or near daily basis because they're using painkillers."

Dr Brian Hope: 'Brain gets used to painkillers'

People with a family history of tension-type headaches or migraine may also be genetically more vulnerable to medication overuse headaches. They could be susceptible when taking pain relief even if it is not for headaches.

The new guidelines for doctors in England and Wales advise telling sufferers to immediately stop taking all pain relief. However, this will lead to about a month of agony as patients contend with regular headaches without pain relief, until symptoms eventually improve.

The panel said other options for controlling any underlying headaches, such as preventative treatments, could be considered.


The guidelines also include a recommendation for acupuncture in patients susceptible to migraine and tension headaches.

Drugs causing overuse headaches

  • Paracetamol, aspirin and non-steroidal anti-inflammatory drugs on 15 or more days per month
  • Triptans, opioids, ergots or combination analgesic medications on at least 10 days per month

Source: NICE

"We would expect that to lead to more people getting acupuncture, but given there is good evidence to show this is effective for the prevention of both tension-type and migraine-type headaches then that is a good thing because people are getting access to an effective treatment," Prof Martin Underwood said.

Doctors have also been asked not to refer patients for brain scans "solely for reassurance" that they do not have a brain tumour. The NICE panel said a tumour would come with other symptoms such as a change in behaviour or epilepsy.

The chief executive of the Migraine Trust, Wendy Thomas, said: "The guideline will assist with accurate diagnosis, appropriate referral and evidence-based information for those with troublesome and disabling headaches.

"It will also raise awareness of medication overuse, which can be an issue for those with severe headaches.

"People with disabling migraine will experience improved quality of life as a result of this guideline."

Dr Fayyaz Ahmed, the chair of British Association for the Study of Headache, welcomed the guidelines.

He said: "Headache is the most prevalent condition and one in seven of the UK population has migraine.

"The condition puts an enormous burden on the healthcare resources and the economy in general."


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  • rate this

    Comment number 19.

    If I have been supply teaching all day my headaches are caused by lack of refreshment. Teachers often don't get proper morning and lunch breaks. Solution? 30 minutes at home with a cup of tea. Headaches caused by bugs, I treat with a tablet ASAP, usually neurofren.

    My wife rarely takes anything for anything. Probably correctly, she feels that her body, given a chance, can fix itself.

  • rate this

    Comment number 18.

    People using pain relief for 10 to 15 days a month really need to seek medical advice, in case they have a serious condition, not self medicate.

    Personally, I rarely take painkillers, I used to suffer from migraines as a child, and was always sick, so painkillers were thrown up during that phase, and I just had to go lay in a dark room, with a damp cloth on my forehead until it went away.

  • rate this

    Comment number 17.

    My now ex-wife had a paracetamol dependency, of which I was unaware.
    This resulted with my daughter being born with severe problems that will affect her for the rest of her life, and my ex- wife after our divorce almost dying of kidney failure.
    With the plethora of outlets - supermarkets who sell very large packs of high dose painkillers with no control, people with problems are not detected

  • rate this

    Comment number 16.

    8.Lemog - and no one is asking you to.....just not to take them for more than 15 days a months.

    If you get headaches on more days a month than that then it's time to see your Dr......

  • rate this

    Comment number 15.

    People seem to resort to pill popping to quickly, it will have side effects like anything not taken in moderation. You are after all attempting manual adjustment of your bodies chemistry for personal comfort.

  • rate this

    Comment number 14.

    The stress of life in the UK is the biggest cause. In civilised countries people work to live they don't live to work.

  • rate this

    Comment number 13.

    What hope for me then? The NHS has so far taken two years to operate on one of two collapsed hips, but is quite happy to prescribe 12 codeine, 8 paracemtamol, anti-inflammatories and two nerve blocking drugs a day.

  • rate this

    Comment number 12.

    Millions of headaches could be avoided if the pub was as a well!

  • rate this

    Comment number 11.

    I rarely get headaches, when I do I prefer to find the cause & deal with it rather than take painkillers. Having said that I take very strong doses of painkillers regularly for other extremely painful things as a result of having had both legs crushed & shattered, so that might be the reason I rarely get headaches, I think lots of research should be done before blanket statements are made!

  • rate this

    Comment number 10.

    @ krokodil 1
    "That's going to upset the hypochondriac's..... lol"

    The new NICE guidelines will also upset the Big Pharma profiteers who love to encourage Doctors to over-prescribe and for us all to use and become dependent upon vast quantities of medications that are too expensive, often unnecessary or in cases like this actually harmful.

  • rate this

    Comment number 9.

    I am a migraine sufferer (with aura) and discovered that the pain following my migraine was greatly diminished if I took paracetamol during the aura phase. The problem was that my migraines were occurring more and more often (2x per week). I stopped taking paracetamol for unrelated reasons and lo and behold I also stopped having migraines a few weeks later and did not have one for 6 months.

  • rate this

    Comment number 8.

    Headaches? ugh, of all the "minor" ailments that can affect us on a daily basis, headaches are up there along with, tooth, ear and stomach aches. If ever I feel a headache coming on I pop a pill straight away, there is absolutely no way that I am going to avoid taking pain killers just in case they may actually induce a headache.

  • rate this

    Comment number 7.

    "causes headaches when used more than 10 - 15 days a month". Paracetmol makes my headache worse if I take more than one dose in 24 hours! Found this out for myself years ago, so now I alternate pain relief taken only when headache is really bad.

  • rate this

    Comment number 6.

    2.schoolies - "This news is enough to give me a splitting headache because it is so vague. Which painkillers, what dosage, how often?...."

    Any pain killer, at a dose approaching the maximum dose, taken for a length of time beyond that which Dr has perscribed it.

    It you self medicate with paracetemol don't take it every day for more than a week or two without speaking to your Dr.

  • rate this

    Comment number 5.

    I think the big part of this story that's missing is that on the whole off the shelf painkillers don't actually work to any significant degree, the same as "cold remedies" we are pursuaded to buy.

  • rate this

    Comment number 4.

    My partners doctor tells him to take paracetamol every day for the pain of his arthritis!

    So now what?

  • Comment number 3.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 2.

    This news is enough to give me a splitting headache because it is so vague. Which painkillers, what dosage, how often? Should I stop taking my daily aspirin? Come on BBC print the facts

  • rate this

    Comment number 1.

    Doctors have also been asked not to refer patients for brain scans "solely for reassurance" that they do not have a brain tumour.

    That's going to upset the hypochondriac's..... lol


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