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 139.

    "I was told by the GP that eating cheese or drinking wine were the main causes of headaches. I told him I'm lactose intolerant and teetotal.
    He then admitted he had no idea what else would cause so many headaches and suggested that I take paracetomol."

    Sounds like a good honest doctor. Knows his limits. Pragmatic answer. Excellent medicine.

  • rate this

    Comment number 138.


    Your completely right in my eyes. People tend to forget our bodies change with each generation. For last millennia we have been physical in everything we do to survive, now most sit down all day, from drivers to office staff and then they come home and sit again to watch tv.
    i only eat when hungry and never have set times, cycle 20+ miles a day and keep life simple. I'm relaxing now!

  • rate this

    Comment number 137.

    The writer of the article seems to be making the common mistake of thinking a migraine is a headache. As one of those who suffers migraines I know that a migraine is NOT a headache. I often hear people say "Oh my god I have a terrible migraine".
    I assure you, if you had a terrible migraine you would be completely incapacitated.

  • rate this

    Comment number 136.

    It almost makes me wonder if this effect is engineered into the product to ensure people keep buying them.

    The drug companies would collapse if anyone found a cure for headaches, colds and flu. No more selling us a few pennies worth of drug for £5 a box.

  • rate this

    Comment number 135.

    @116: No that's completely incorrect. If they only studied people with headaches or people who regularly take painkillers then 1 in 50 of those groups is not 1 in 50 of the population because not everyone in the population suffers with headaches or regularly takes painkillers. That is why I asked the question. I hope I have spelled that out well enough for you.

  • rate this

    Comment number 134.

    I use an osteopath rather than a chiropractor. There are many unscrup chiros in UK; 1 of which promised a cure me if i signed up for 10 sessions, Alarm bells. My osteo ensures my back and neck are moving correctly, treats if required. For those suffering from chronic headache i recommend it, also ask about cranial osteopathy. Always check with gp before signing up to any alternative treatment.

  • rate this

    Comment number 133.

    129.iplaybass - no there won't, the evidence for this has been around for quite some time, but is now being publicised after a rigorous review process by many experts.....

  • rate this

    Comment number 132.

    Those of us who know severe migraines or the unbearable "cluster" headaches know that any "over the counter" pills are no help at all - a waste of money.
    This symptom may be caused by using these pills too much causing an addiction which has to "fed" by taking even more pills.

    Cure the addiction - solve the problem.

    Stop drug companies advertising useless expensive pills with fancy names.

  • rate this

    Comment number 131.

    I was told by the GP that eating cheese or drinking wine were the main causes of headaches. I told him I'm lactose intolerant and teetotal.
    He then admitted he had no idea what else would cause so many headaches and suggested that I take paracetomol.

  • rate this

    Comment number 130.

    Speaking as someone who is going through the process of coming of all pain medication for Migraines’, after a year of chronic pain I'll try anything if it will reduce the migraines and give me my life back. As for the comments about just popping pills by others all the medication I was on was prescribed by my Doctor so I was never self medicating, were not all pill poppers.

  • rate this

    Comment number 129.

    And, as usual, in a couple of months time, there will another study telling us the complete opposite!

  • rate this

    Comment number 128.

    117. The Official Deceivers
    The global pharmaceutical industry has not invented a single absolute cure for any disease,
    Complete & utter garbage. Penicillin is an absolute cure for a hundred different diseases. Thats just one drug.

    That is unless you expect the pharma industry to make something that cures 100% of people, 100% of the time 100% safely which is impossible.

  • rate this

    Comment number 127.

    I rarely get headaches but when i do i prefer to wait it out to see if it goes on its own before taking pain killers. I'm one of them that don't take medication unless it something serious that simply won't go in time.
    I believe people become immune to painkillers and they can hinder your bodies natural ability to heal on its own.

  • rate this

    Comment number 126.

    "I am not exaggerating my figures; I have never over the age of 12 experience a lasting painful headache."

    Well bully for you. Those of us with serious headache conditions aren't quite so lucky. Come back and be smug about no painkillers once you've had an episode of cluster headaches. As they say: data is not the plural of anecdote. Dreadfully onesided article BBC...

  • rate this

    Comment number 125.

    To the 'jolly hockeysticks brigade' who advise me to get on with it, lie down till the migraine goes away, or go on a bike ride- my migraines have progressed over 25 years-now every 24 hours. I'm self employed- I can't afford to lie down-I have to pay the bills, not 'go on the sick'.
    Been under the doc for years-I don't just pop pills-his last comment 'I need to have a think' He's still thinking.

  • rate this

    Comment number 124.

    Dehydration is a major cause of headaches. A glass of water should be the first course of action.

  • rate this

    Comment number 123.

    I think we're way too drug dependent these days, we go to the doctors about anything and everything. I suffer from headaches often and try to avoid taking painkillers as much as I can, though I have a knee condition which makes it unavoidable sometimes. If I get a headache the morning after taking medication, I just sit it out. I fully support this article, we need to come off the drugs!

  • Comment number 122.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 121.

    I take strong pain relief for my jaw. I've also had migraine/headaches for at least 40 years. I now also read that overuse of paracetamol can lead to deafness in women, so they say - great! A day, without having either a sore face or head, would be great! It did go away for 5 months last year, when I didn't need anything, but it just came back. I'd rather be not taking anything.

  • rate this

    Comment number 120.



    Since the 1640's the business men that took over the reigns from the tribal chief have sought to accelerate control of the herd to their benefit.

    They replaced the 'king', they expanded their business empire- not Englands, they enclosed our land, they put down embryonic revolutions.

    It took major wars to impede their progress, and now the internet is finally undermining them.


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