Painkillers 'are the cause' of millions of headaches

Woman in pain

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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 259.

    Peter_Sym: "If it wasn't for pharmaceuticals I've have died twice before age 12."

    Which would have been a medical miracle. Most folk only die once.

  • rate this

    Comment number 258.

    I wish more research could be done to educate doctors on causes & treatments of different types of headaches. After years of agonising headaches & lack of support from my doctor, I saw a neurologist who told me I was suffering from tension headaches. However despite spending thousands of pounds on different treatments I have still not found a cure and have only found relief from muscle relaxants.

  • rate this

    Comment number 257.

    It's a shame the professor felt the need to talk about acupuncture.

    It's been shown time and again to be no more than a placebo, and one with significant risk of infection due to bacteria on the skin hitching a ride on the needles.

    Painkillers should be used sparingly, if you have a persistent headache talk to your doctor and try to figure out what's causing it. But acupuncture is quackery.

  • Comment number 256.

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

  • rate this

    Comment number 255.

    I've have suffered with agonising headaches for several years and fell into the trap off constantly taking pain killers to just try to get through each day. A few years ago, I stumbled across an article on medication overuse and stopped taking painkillers for a few months. Unfortunately, despite struggling through the pain everyday, I saw no change in my headaches.

  • rate this

    Comment number 254.

    248. Peter
    Its high time the medical and pharmaceutical professions admitted that most of the drugs that are prescribed will cause many serious and often long-term side effects and are to be avoided.
    You mean the leaflet included with all drugs listing every side effect ever reported with that drug isn't enough for you? If it wasn't for pharmaceuticals I've have died twice before age 12.

  • rate this

    Comment number 253.

    Nothing but a confirmation by doctors of the benefits/disadvantages of the "hair of the dog" cure for that one type of headache caused by over-indulgence the night before.

    So now it applies to the 200 other odd types of headache as well

    Soon our genius doctors will realise all people die eventually and no doubt will let us know.

  • rate this

    Comment number 252.

    I never take painkillers, and have bad arthritis in my knee, and do a physical job. Pain is something that can be endured, and as you get used to it, it is less painful. Headaches as usually dehydration, drink more water and they tend to go. Painkillers should be a last resort, like all drugs!

  • rate this

    Comment number 251.

    My father suffered from atypical face pain for the last fifteen years of his life. It got progressively worse and no painkillers worked. Some days, he couldn't stand the pain and would bang his head on the wall. He had very few pain free days. I hope this feature doesn't give the impression that treating head pain is easy. It isn't. If it were easy, It would be sorted.

  • rate this

    Comment number 250.

    Yes aspirin is cheap to buy however some people have complaints where they are told not to take over the counter medicines, some are told to take it even if they don't want it, diabetics for example and others pay for their scripts a year in advance which covers all items personally I suffer from a chronic headache for20 years the cause is known but their is nothing that can be done

  • rate this

    Comment number 249.

    I have had an inoperable pituitary macroadenoma for 2½ years. Before this I never resorted to taking pills just to clear a common headache. Using opioids for the debilitating pain from my condition is not negotiable, however, I try to avoid taking more than necessary. These are strong drugs and should be respected, not used for 'lifestyle' headaches. Tackle the cause not the symptoms.

  • rate this

    Comment number 248.

    Its high time the medical and pharmaceutical professions admitted that most of the drugs that are prescribed will cause many serious and often long-term side effects and are to be avoided. Symptoms from the body are telling us something and it needs a bit of investigative work by doctors and consultants who are paid a fortune to find out what. Often food or pharmaceutical related.

  • rate this

    Comment number 247.

    It's making non stories like these for the public to comment on the BBC News wesbiste that cause headaches..
    Paracetemol Extra with caffiene are fantastic when you have a headache.

  • rate this

    Comment number 246.

    The pill culture in society drives me crazy. At the first sign of any discomfort people seem to turn to pills without thinking of why they might have a headache. Are they dehydrated? (Have some tea!) Staring at a screen for too long? (Take a break!) It's the same with taking vitamin pills - eat some fruit! It's not really a surprise that taking a lot of unnatural pills is bad for your health.

  • rate this

    Comment number 245.

    I coped with migraine for years by taking prescription tablets from my doctor, but decided I didn't want to get dependent on drugs, so after speaking to my doctor I went down alternative routes. Visiting a chiropractor has helped relieve migraine pain and I've now been able to stop taking my prescription and the migraines have greatly reduced to the point where I rarely have to take painkillers.

  • rate this

    Comment number 244.

    #242 Agreed. Thank you. And the wage I get developing new drugs is not particularly impressive either. However even being totally cynical Rob is wrong... dead patients don't continue to need drugs so the pharma industry has a very vested interest in keeping you alive as long as possible . A total cure means you live to old age and get more chronic conditions.

  • rate this

    Comment number 243.

    You need to be careful with sweeping statements like that! I have enough controlled painkillers per day to flatten an average elephant because I had the bones & several major muscles smashed & macerated along with all the other soft tissue, my pain threshold has been measured & is considerable, my pain level alters blood chemistry & has to be controlled! I don't have headaches!

  • rate this

    Comment number 242.

    "When will we all realise the pharmaceutical companies have zero interest in our health and well being? Their sole interest is PROFIT!!!"

    Just like everyone else that works, few do the job for any other reason than profit (a wage to you & I) so why pick on pharmaceuticals?

  • rate this

    Comment number 241.

    I've suffeedr from depression and achey heads for about 10 years now and for all the doctors I've seen I'm still not cured.

    It is true that some painkillers are very addictive and cause rebound headaches but until they find me a cure I'll be taking the pills.

    It's also worth pointing out that we all have different tolerances to pain and for people like myself an achey head is a nightmare....

  • rate this

    Comment number 240.

    And this is news? Does anyone NOT know by now codeine causes headaches? And it's addictive too.


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