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 199.

    The point is not that painkillers don’t have their uses, rather that using them can have side effects. Often the root cause of persistent headaches can be tracked down & eliminated more effectively.

    I also agree with the point a Migraine is nothing like a normal headache, is much more debilitating & pain relief is often not effective with Migraines anyway.

  • rate this

    Comment number 198.

    I am a retired medical doctor, and I have never known "pain killers" to be the source of pain or headache, or being addictive particularly Aspirin and Paracetamol!!

  • rate this

    Comment number 197.

    @Bedinog, if you’re having migraines every 24 hours you really need to investigate why. I hope and assume you are being seen by specialists.

    My cousin used to suffer from frequent migraines, and the drugs did little to help. What helped for her was seeing a specialist who suggested avoiding certain foods in her diet. Now she very rarely has them.

  • rate this

    Comment number 196.

    I have to take up to eight Paracetamol each day to control the pain of Arthritis as the NHS is so stretched that I cannot have the operation on my knees that I need. Yes I do get headaches occasionally but the alternative is not an option right now as the pain in my joints is quite debilitating most of the time.

  • rate this

    Comment number 195.

    Such marvellous advice below me.

    We have a lot of doctors reading the BBC website apparently.

    Most of you should be ashamed: you have posted utter twaddle. And some of this utter twaddle has positive ratings??!??!??

    This country is getting dumber by the day.

  • rate this

    Comment number 194.

    There are various types of headaches as there are various types of migraines. Not all have one root cause, but the body displays symptoms.

    I agree with other posters that a full eye examination by an ophthalmic optician is a crucial part of health care. Not just about needing specs.

    Ophthalmic opticians can diagnose numerous physiological problems early and provide fast referral for NHS care.

  • rate this

    Comment number 193.

    @Defn28 I think research has shown no overall link with Reiki and or Chiropractic. I am interested that the BBC report that their Doc knows of research that Accupuncture has statistically helped. All research I've seen has shown no overall bias.
    However, some headaches are made worse\caused by stress\tension and relaxing and lowering BP can help. Reiki and such help will a patient to relax more?

  • rate this

    Comment number 192.

    Asked the pharmacist for some headache tablets one day. They did exactly what they said on the tin and I've never experienced so much pain in my life.

    Now I always ask for tablets to *cure* a headache.

  • rate this

    Comment number 191.

    May i also advise/suggest that people with recurring headaches/migraines etc try Reiki and/or Chiropractic as it helped a past work colleague i knew who suffered lifelong migraines... Just a suggestion.

  • rate this

    Comment number 190.

    Let me clear up one misconception. Taking regular painkillers like paracetamol do not cause migraines. They might cause a slight headache or joint pains but proper migraine is in a totally different class. You cannot function with one of those.

  • rate this

    Comment number 189.

    "Bit of a alarming, OTT headline, isn't it ? ... 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"

    If only that was the case for me. If I take any over the counter pain killer they only aggravate the migraine for me. Acupuncture & massage help though.

  • rate this

    Comment number 188.

    183. johncbbc
    I thought that a small dose of aspirin each day was a GOOD thing - helps reduce the probablity of heart disease.
    When are thse people going to start singing from the same hymn book?
    The 'small dose' really is small 1/4 tablet a day. Not 2 tablets 4 times daily.

    The choice you have is whether reduced risk of heart disease is worth a headache? Nothing is side effect free

  • rate this

    Comment number 187.

    I get headaches due to very bad sinus probs which effect the ear and now under the eye - sadly my gp despite the xray evidence doesnt realise to stop the head pain I need the ear/sinus treatments - painkillers dont work - though my body needs them to be able to be active - had so many accidents be refuse to lay down. Biggest cause of any headache is stress of the body in many forms - meditation

  • rate this

    Comment number 186.

    173.Weford - unusual that you get that on such a relatively mild "dose" but it a well know cause of headaches.

    Whenever we look to reduce/cut out coffee consumption etc it does need to be done through a slow tappering off - the headches you can get it too sharp a reduction are quite something though

  • rate this

    Comment number 185.

    The bigger reason for this is that the modern world is a culture of quick fix in order to carry on without taking the proper time and care to stop and properly diagnose what is causing the problem. "Time is money!" spout the corporate greedy. Next week we will see headlines of 'Absence From The Workplace Costing Taxpayers Billions' and round we go again...

  • rate this

    Comment number 184.

    Just wondering if any of the people with regular migraines keep a complete diary of daily activities, food and liquid intake?

    If a migraine is caused by a chemical release In the head (not in the brain!), then there has to be a trigger for why your body is doing it.

    Just a thought.

    I don't eat bacon because it give me bad acid, ham & pork is ok? Sometimes its worth the pain though!

  • rate this

    Comment number 183.

    There now... I thought that a small dose of aspirin each day was a GOOD thing - helps reduce the probablity of heart disease.
    When are thse people going to start singing from the same hymn book?

  • rate this

    Comment number 182.

    For all you migraine sufferers still struggling with useless doctors - ask for sumatriptan injections. These are self administered usually into the thigh. Just a second or two of a sting then 15 minutes later the migraine has gone. They have been a lifesaver for me.

  • rate this

    Comment number 181.

    The types of heavy headaches I get which effect my eyes and in my temple, taking anything other than Ibruprofen is just not good enough to help me. Migrine or headache is the only time I will take a painkiller, and never more than just one to get rid of it.

  • rate this

    Comment number 180.

    With arthritis in my neck, both knees and one hip, I take prescription painkillers every day - no choice, really. I've known about the 'headache effect' for many years but the ones I take don't affect me that way. Maybe I'm the exception which proves the rule.


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