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 159.

    @153.Shushannah Do you suffer from Migraine or a long term debilatating condition requiring analgesics?

    Thought not!

    Homeopathy works for you then in your circumstances.....

  • rate this

    Comment number 158.

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

    There are 2 things to take into consideration.
    1-the pharmacology industry in Britain makes an enormous amount of money out of us for prescribed & non prescribed drugs.
    2- with just about every drug there is a benefit and a side effect of taking that medication. One has to be evaluated against the other.

  • rate this

    Comment number 157.

    It's very easy for people who don't suffer from migraines and tension headaches to suggest avoiding painkillers. I experience both, and the choice between terrible pain and taking a pill to end that pain is one which is really no choice at all. I've tried many alternative treatments and had numerous checks, but in the end only the pills make life bearable.

  • rate this

    Comment number 156.

    Twice recently for a bad back and a whip lash injury I was told by two separate GP's to take Ibuprofen 4 times a day for a month, my partner was told the same by her GP, sounds like standard instructions to me.

  • rate this

    Comment number 155.

    If an "over the counter" pill can cure your headache pain then you don't really have a headache worth talking about.

    Only the drug companies with their fancy advertising for pills with fancy names and packaging that can be bought for about 90% less want you to believe they are effective.

  • rate this

    Comment number 154.

    I have known this for years. Headaches are often caused by eye strain or dehydration and people need to listen to the pain and change their activity - stop reading, have a glass of water and go outside for fresh air, is the best cure for most common headaches, in my experience. Killing the pain only enables people to continue doing what's causing it, making it worse once the medicine wears off.

  • rate this

    Comment number 153.

    I have found that just drinking a glass of water can relieve most, if not all, my headaches...obviously they are caused by dehydration as much as tension. I rarely take painkillers.

  • rate this

    Comment number 152.

    My wife suffers from a permanent back injury from work, that even with surgery would not definitely cure. If she didn't take painkillers she would be unable to work.

  • rate this

    Comment number 151.

    I'm not surprised to find at the end of the article the real reason for this "advice":"The condition puts an enormous burden on the healthcare resources and the economy in general." Rebound headaches,as they're called, are a well known phenomenon & one migraine sufferers are well aware of,but when the NHS does damn all to help, self-medication is the only option.The issue here is money not health.

  • rate this

    Comment number 150.

    128. Peter_Sym
    Penicillin was not invented by global pharma and unless you've been living under a rock for the last 9 years, drug resistant bacteria looks set to make penicillin ineffective sometime soon. And yes Peter, unless its 100% in all respects it isn't a cure and only benefits the rich firstly and then, sadly too often, those too ignorant to know they are guinea pigs. All drugs are abuse.

  • rate this

    Comment number 149.

    Bit of a alarming, OTT headline, isn't it ?
    I mean, it's not like someone coming home from a stressful day at work, with a migraine, can pop to the cupboard and instantly whip out a home acupuncture kit. I rarely get migraines, but for me anyway, 2 solpadeine max tablets dissolved in a glass of water will kill any migraine within the hour, or, 2 paracetamol tablets within a couple of hours.

  • rate this

    Comment number 148.

    136. Giles Jones
    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.
    Where do you buy your paracetamol? I get mine from Asda for 16p a packet.

    Incidentally all the over-counter painkillers are a million years past patent. The ASDA stuff is made in India. The profit on it is virtually 0.

  • rate this

    Comment number 147.

    Well, there are no drugs in the jungle. Might be cos the parrots eat 'em all.

  • rate this

    Comment number 146.

    An enormous amount of illness is caused by working beyond the natural 20 hour limit. I amazes me that the BMA doesn't work towards setting the natural limit as the legal limit.

  • rate this

    Comment number 145.

    Lets all go back to chewing Willow Bark for the Salicylic Acid once it has been diluted out of existence chanting the Homeopaths mantra 'Water has a memory'

    OR let's use painkillers in a fit and proper manner as they are intended. whilst avoiding the mass panic and book burning (The Pharmacopoeia in this instance)

  • rate this

    Comment number 144.

    This blanket "do not take painkillers often" is worrying. People have killed themselves because of the continuous migraines. If you don't get them, don't comment, you don't know the pain. Doctors DO encourage finding alternatives to stop migraines. This is the best way. But until you find a way, if paracetamol stops them during the initial phases, do not let these comments make your life worse!

  • rate this

    Comment number 143.

    We keep a pack of paracetamol in the house. By the time we need one they have passed the "use by" date. A walk up to the pharmacy for replacements usually clears the headache.

  • rate this

    Comment number 142.

    Migraines are not just a nuisance, a bad attack totally cripples me with the excruciating pain and vomiting. At the first sign of a headache I take a painkiller, and yes, I probably take more than I should in a week. But I can't afford to risk a migraine with 2 small kids to look after and a job to hold down. When I was pregnant, I gave up painkillers and suffered awful migraines as a result.

  • rate this

    Comment number 141.

    Spare a thought for those with chronic pain conditions. I take strong pain relief for a back condition that will never improve. I would be unable to work, or even get out of bed without their help. I am only 46 and take a mixture of anti-epileptic drugs and opiates, and will have to use them for the rest of my life as part of a pain management program!

    You just have to put up with the headaches.

  • rate this

    Comment number 140.

    30: "Exersize" is a rather pleasing wrong spelling but I fear you thought it was right.

    As for you, 120, you get the CBP. Commander of the Order of British Paranoids.


Page 12 of 19


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