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 179.

    66 - Robert
    "I have never over the age of 12 experience a lasting painful headache."

    All I can say then is - Aren't you lucky?

  • rate this

    Comment number 178.

    If i get a bad headache which warrants chemical relief (which is rare) i take Ibuprofen not painkillers. Pain killers mask a problem. Headaches are usually strain or inflamation. Ibuprofen reduces inflamation thus dealing with a problem rather than masking it. Fresh air and stepping away from the computer/laptop/tablet (which we are all slaves to) helps wonders!

  • rate this

    Comment number 177.

    None of this advice is helpful to people who have to take painkillers for longstanding medical conditions who then start getting headaches as well. Stopping the opioid painkillers is not an option for my partner until a cure is found for his underlying condition.

  • rate this

    Comment number 176.

    My wife gets severe migraines, no doc/specalist can do anything but prescribe painkillers. Several years ago she had to stop taking anything more powerful than Paracetamol due to them causing headaches. She now has less but has no way to reduce the pain. Mostly because modern medicine still knows very little about the brain. Docs prescribing codine long-term don't help though!

  • rate this

    Comment number 175.

    To all those who think "headaches" are just the result of poor lifestyle habits - "expletive deleted". Lucky you who only need a cup of tea & a walk round. Stop assuming that what works for you is a suitable panacea for all.

  • rate this

    Comment number 174.

    First hand experience of this. It gets worse too. You end up hooked on painkillers - if you don't take them you get headaches! That needs to be on the box!

  • rate this

    Comment number 173.

    I have found caffeine withdrawal causes headaches. I don't drink much tea and coffee - two or three cups a day, maybe - but find that if I haven't had any for some reason, I get a headache which disappears as soon as I have a cup. Agree that eye strain and dehydration can cause it, too.

  • rate this

    Comment number 172.

    I love the 'I rarely get headaches but if I do I have a jolly good walk' brigade, congratulations we really needed to know that. Maybe if you fleshed it out a bit and told us about your daily bowel movements too.

    This is about people with cronic conditions and the implications to ~2% who have a reaction to the meds they are taking.

  • rate this

    Comment number 171.

    As a migraine sufferer it really irks me when headache and migraine are bracketed together. I've had migraine for 30 years. It's a severe debilitating headache/sickness affecting day to day life during an attack. It can't be cured by "having a drink of water" or "lying down with damp cloth on head" or popping a painkiller like paracetamol. Those "cured" probably didn't have migraine to start with.

  • rate this

    Comment number 170.

    My husband became addicted to a well know (branded) over the counter pain killer. He was up to 8 a day and did admit occasionally to going over. About 2 months ago he went 'cold turkey' and has not reached for one since. He admitted part of it was the fizz when disolved in water (dispersible tablets). He is really pleased he stopped no to mention to money he is saving!!

  • rate this

    Comment number 169.

    #150 Glaxo-Smithkline aren't 'big pharma'? Fleming noticed that mould killed bacteria, it was Chain & Florey who managed to synthesise enough of it to make drugs (and shared the Nobel)

    NOW you want 100% safe, 100% effective in all people of all ages, sex & lifestyle and is now also evolution proof (and presumably very, very cheap)? What else in any industry meets your standard?

  • rate this

    Comment number 168.

    NB They are talking about headaches OR migraine - they are not the same. I've suffered from headaches periodically for as long as I can remember but migraines only a few years. I couldn't use a painkiller for migraine as I wouldn't be able to keep it down. But the self-propergating nature of Painkillers due to overuse for headache has been known for years - this is not news.

  • rate this

    Comment number 167.

    Those who don't suffer from migraine can't understand what it feels like. As well as vomiting, visual disturbances, light aversion, pins&needles in fingers, there is the disabling, violent pain. These are not 'tension headaches' that can be fixed with a couple of paracetamol. Sumatriptan (not a painkiller) quickly halts my migraine attacks and NOTHING is going to stop me taking them when needed.

  • rate this

    Comment number 166.

    I have to say I too rarley have headaches and when I do even more rarley use pain killers, as I prefer just to tolarate the pain and wait it out rather than expose myself to unnecassary drugs.

    Maybe that's why I don't get many headaches, when I do it's generaly eye strain or posture.

  • rate this

    Comment number 165.

    This is incorrect. Migraines go through various stages. The more you get them the more you spot the stages and hopefully some root causes.

    In the early stages, if caught in time, over the counter painkillers can stop them or make them bearable.

    Of these, paracetamol is arguably the least dangerous at low doses.

  • rate this

    Comment number 164.

    I'm pretty annoyed at this article.The BBC have offered no real analysis of the claims made by NICE,but rather have swallowed them hook line & sinker as fact.Headaches & migraines could more appropriately be seen as a reaction to the intolerable stresses people experience today in their home & working lives(eg employers wanting more for less;sacking people on a whim & no comeback).Poor journalism.

  • rate this

    Comment number 163.


    If work is giving you an headache, then I would change your job. Having long working hours isn't good if you are only doing something for the money. If your doing something you enjoy its a different ball game, but if your physically/mentally tired then you stop as that is what your body is telling you.
    Having children is a full time job, doing a day job too & your going to have an headache!

  • rate this

    Comment number 162.

    If you can manage a headache without pain relief then you've never had a full-on migraine and I too am encrossened by people with headaches claiming they have a terrible migraine. I also envy people with aura who can deal with their migraines - mine come on in the night and wake me up with agony. I also can't move my head, sound and light are intolerable and my face gets numb on the painful side.

  • rate this

    Comment number 161.

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

    This is really offensive. When I start a cluster headache episode, paracetomol kills the headaches dead. Later I need specialist neuro-inhibitors. When you know what you are talking about please comment again. Try to be less patronising & ignorant perhaps?

  • rate this

    Comment number 160.

    Headaches are a symptom not a medical condition that popping pills resolves - popping pills with a hangover masks that symptom until rehydration and detox of the blood has happened due to the other things you do like drink lots of water or juice etc.
    Anything that requires pills for more than a day is something else and if your GP simply gives you pills it is their way of saying , I don't know.


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