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 239.

    When will we all realise the pharmaceutical companies have zero interest in our health and well being? Their sole interest is PROFIT!!! They do not make drugs to make us better, they make drugs for PROFIT and pay Govt huge subsidies so they can continue to make PROFIT despite the overwhelming evidence of their unscrupulous ethics and business practices

  • rate this

    Comment number 238.

    This effect of painkillers, the 'rebound headache', has been well known for many years. Moreover, standard painkillers are of little use against migraines and cluster headaches.

    It's taken the National Instistute of Cost Elimination a long time to catch up with what's common knowledge amogst sufferers!

  • rate this

    Comment number 237.

    @ 137.
    "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."

    As a sufferer of thankfully infrequent migraines I couldn't agree more. In the case of mine it's a choice of a couple of ibuprofen and it's gone in 10 minutes, or do nothing and turn into an incapable fetus for four hours.

  • rate this

    Comment number 236.

    This isn't new - or news - it just happens to be getting more common due to the hours people work and how we work - don't sit in front of the pc or tv all day and night, change what you are looking at regularly, reduce the caffeine. OK it doesn't help migraine sufferers - but they need to find out what triggers the migraine, in my case it's Cheddar cheese

  • rate this

    Comment number 235.

    Painkillers are a last resort and should be taken only at times of severe or persistent pain. I would not take pain killers for a headache, and that includes migraine. For mild to moderate pain, just live with it. Develop a pain threshold. Anyone who takes painkillers daily is either a wimp or an imbecile, or more probably both.

  • rate this

    Comment number 234.

    This article is not helpful for those who suffer from migraines. My son was 7 years old when he had his first migraine and it involved a trip to A&E. He had to have medication available at school. I felt guilt because he inherited the condition from me and my family. Unless you suffer you can not understand how debilitating headaches can be. More research is needed not unhelpful advice.

  • rate this

    Comment number 233.

    People should treat these types of articles like horoscopes. Digest the information and decide if it is relevant to your particular circumstances. I do think the title is misleading though. It should say something like "Painkillers could exacerbate headaches through prolonged use". But then that is something that could be surmised without the need for empirical evidence.

  • rate this

    Comment number 232.

    My advice for headache sufferers.

    Get your heart checked. Request a sleep study or 24 hr ECG test.

    Don't let your Dr just listen to it for 30 seconds, request the full over night test.

    Long term headaches are often a sign the heart is doing something a little odd, usually caused by stress and tension. Beta Blockers can really help!

    Yet another ploy to reduce people using the NHS and GPs IMHO

  • rate this

    Comment number 231.

    those people who don't suffer from recurring headache should count themselves very lucky!.
    i suffer stress and sinus pain headaches regularly,symtoms i treat with painkillers ........without these life wouldn't be worth a lot.

  • rate this

    Comment number 230.

    I agree with the doctors are saying. A few months ago I realized I was taking painkillers almost as a reflex, so I stopped taking them. After a few uncomfortable days they have mostly disappeared. Only when I do things like sleep to long may I have another one, but even then it's minor. It won't work for everyone of course but I think it's worth a try.

  • rate this

    Comment number 229.

    #225 I was suffering a weird mix of symptoms about 18 months back (mostly extreme backache but also headaches, inflamed joints, concentration problems, gut problems). Turned out iboprofen (taken for the back ache) was causing stomach bleeds (even 2-4 tabs a day). Exercise, reduced caffeine (better sleep) and no iboprofen resolved everything quite quickly. Back pain is better too.

  • rate this

    Comment number 228.

    Best to keep their use down as much as possible, but I still take paracetamol when I sometimes need them though.

  • rate this

    Comment number 227.

    When I was a kid, my Mum told me that painkillers can cause headaches. I'm 50 now, so it's hardly news.

  • rate this

    Comment number 226.

    I suffered from chronic tension headaches for 15 to 18 years. My guess is that most people who have had headaches for any length of time will have come across the advice on rebound headaches years ago. But the sufferer will continue to try anything in the hope that it will help. I found trigger point therapy v useful - and now rarely touch a pill.

  • rate this

    Comment number 225.

    I used to suffer from terrible cluster migraines which failed to respond to medication. I was lucky enough to be able to 'cure' myself with:

    - Exercise! I took up running and I believe good cardio exercise is the most important aspect.
    - Limit caffeine intake.
    - Painkillers, only when absolutely necessary.

    This works for me, and it worked for my other half too.

    Everyone is different though.

  • rate this

    Comment number 224.

    We have a daughter suffering from NDPH, so are well aware of all headache treatments and, sorry, this is neither new or newsworthy, it's been common knowledge for many years.. That the paper guidelines have finally caught up with common neurological practice simply shows how far behind the Guidelines are or how poor the averge GP's knowledge is on the subject of headaches...

  • rate this

    Comment number 223.

    #205 Why would anyone in their right mind be 'prescribed' aspirin? A packet of 300 mg tablets is 16p. Get than on prescription and its £7-odd. See your GP. Throw away the prescription (if he's mad enough to even write one) buy own aspirin for 16p. Break each tab into 4. All 3 of your problems solved.

    A few prescription drugs are in short supply. Not aspirin. Asda have tons.

  • rate this

    Comment number 222.

    218: Agreed. In fact, "self-medication" is often a false charge leveled against a person who bothers to educate himself or herself, using the many excellent resources now available online, so as not to be a burden to others & overly reliant on health services. If we take good care of ourselves, there will be more resources left for the people in actual health crisis (births, cancer, injury, &c).

  • rate this

    Comment number 221.

    There are severe supply problems of life-saving/stabilsing medications - from cancer to anti-depressant drugs in England and Wales since 2011.

    Why is that? If you ask your pharmacist you are wasting your time.

    The CEOs of major companies (high street chemists) who we rely on to have these important medications in stock, are making more money from selling meds back to Europe/elsewhere. Shameless

  • rate this

    Comment number 220.

    The problem is, painkillers are only meant to be a temporary solution, and treat the symptom not the cause. Until the underlying cause is diagnosed then all you are doing is masking the problem. I don't believe painkillers 'cause' headaches. Headache pain is a warning sign that something is wrong, and artificially overrriding this makes the brain increase the warning i.e. the pain.


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