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 279.

    #275 A medical explanation for that would be sticking needles in randomly promotes endorphin relief (you'd get the same with small electric shocks, hot needles touching but not in the skin) and endorphins relieve pain (even deep heat etc will do something similar). Thats hard science. Its the associated mumbo-jumbo associated with acupuncture that doesn't hold up but maybe adds to the placebo?

  • rate this

    Comment number 278.

    I suffered migraine which resulted in Ibuprofen giving me an ulcer over a stomach vein which started to bleed. The surgeon said he had cases where the first ever tablet had caused bleeding. Stopping taking Ibuprofen the migraines also stopped.
    If ever I get a headache now, very infrequent, I use paracetamol along with a short sip of pure lemon juice, this stops my headaches within 15 minutes.

  • rate this

    Comment number 277.

    I have had headaches since infant's school and I am now 64. I get headaches everyday and take paracetamol and codeine. I have a preventative for migraine - Atenelol - which helps the migraine but not the daily headache. I agree that the painkillers are probably causing them but until some genius comes up with a way of coming off them - what do I do?

  • rate this

    Comment number 276.

    Pain thresholds vary, as do painkillers for individual patients.

    I have Crohn's and undergone many operations. So what? Was prescribed tramadol for post-op pain after my last op - useless to the point I said they must be fake - and I do have a high pain threshold with Crohn's and work in NHS.

    Pain relief is individual - if pain relief fails you must tell staff, don't suffer
    in silence. Tell us!

  • rate this

    Comment number 275.

    @270 cqmeronfrye - "don't equate the absence of evidence with absence of efficacy."
    But we have evidence, and lots of it, that it works no better than a placebo (just like homeopathy). Hell, there are studies shown that acupuncture 'works' just as well with fake needles, with needles in the wrong places, with toothpicks...

    It's not that we don't know how it works, it's that we know it doesn't.

  • rate this

    Comment number 274.

    I suffered with Migraine and had to inject myself this used to happens 3 times a month lasting for 2 days at a time, when I haven't got a migraine I have a headache. Suffered like this since I was 16 and am now 66. I know what they say about taking painkillers is true and it is a vicious circle. How do cope with the pain whilst trying to get of the Co-Codamol and Paracetolmol don't touch it

  • rate this

    Comment number 273.

    263. Ernie "It's quackery. The NHS should not be recommending it or paying for [placebos]" But the NHS makes a fortune from prescribing placebos - otherwise known as selling cheap antibiotics to insistent patients presenting with the cold virus (as you all know, viruses cannot be treated with antibiotics). The indiscriminate handing out of antibiotic placebos is not a good thing.

  • rate this

    Comment number 272.

    @263 Ernie , I agree with you . I had severe stomach pains and thought I'd give acupuncture a go , it didn't work and in the end western medicine found that I was suffering from chronic pancreatitis . I still suffer with it and have to take painkillers to help and I never get headaches .

  • rate this

    Comment number 271.

    @ 241.Sinniberg

    For depression and headaches read The Feel Good Factor by Patrick Holford. I got many of the answers to my low mood and aches and pains following his advice. It is not alternative mumbo jumbo just common sense backed up with scientific knowledge.

  • rate this

    Comment number 270.

    But Ernie 263 is the placebo effect a bad thing? Every time a GP hands out antibiotics for a - probably viral - sore throat its mostly about placebo effect. Whether we understand how it works or not it certainly makes a difference to patients. Moreover even the most rabid proponents of evidence based medicine don't equate the absence of evidence with absence of efficacy.

  • rate this

    Comment number 269.

    'Brain gets used to painkillers.' . . . and in next week's news we'll see if there's a link between the population of woodland bears and the amount of animal droppings found on the forest floor. The issue is not whether the use of painkillers leads to headaches, but how can individuals presenting with symptoms requiring analgesia better be treated. Yet more nice words and no actions from NICE

  • rate this

    Comment number 268.

    Bad health is caused by overly stressful lives. What the government should be doing is making peoples lives easier, and they could start by not keeping people in a continual cycle of debt. A new economic system is needed which leverages technology and provides what people need for as little cost as possible. We don't need to work 5 days a week for 40 years just to survive, technology has advanced.

  • rate this

    Comment number 267.

    I knew this 34 years ago, when I was a teenager, my parents gave me paracetamol every day, their generation were dazzled by the "burning with the white heat of technology" propaganda and thought all prescribed drugs were good. I wondered why I had raging headache hangovers every Saturday while all my mates were fine. Paracetamol abuse also gave my dad very painful neuralgia in his old age.

  • rate this

    Comment number 266.

    "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"

    Placebo or not, if it means I am not vomiting over the floor, unable to stand & in so much pain I'm ready to almost ready to thrash out at anyone that assaults my senses (approaches me) I am glad to have the placebo!

  • rate this

    Comment number 265.

    @ 246.Robinson88

    I totally agree with you first point, we should always think through the causes of a headache (dehydration, eye strain etc) before resorting to pills. However, just eating a peice of fruit will not have the same effect as taking vitamins.

    I beat depression with vitamins & mineral along with excercise. To get the levels of vitamins I take through food would be impossible.

  • rate this

    Comment number 264.

    I find I have fewer headaches when I reduce the time during the day or night when my face is 24 inches from a computer screen.

  • rate this

    Comment number 263.

    @260 cqmeronfrye

    You'll notice that page you linked to has multiple disclaimers about how the evidence in favour of acupuncture is of low quality and is disputed by many scientists. It also takes pains to spell out what the placebo effect is and does.

    It's quackery. The NHS should not be recommending it or paying for it.

  • rate this

    Comment number 262.

    Pain killers are fantastic for those who live with chronic pain and more GPs need to prescribe them not just say 'take paracetamol.' HOWEVER if someone needs to take OTC painkillers for persistent headaches (or pain )they need to get it checked out to see if they need a different kind of pain killer or other medication. Different problems need different treatment,

  • rate this

    Comment number 261.

    #259 hohoho. Depends on what you call 'death'... if its a flat heart line many people have been brought back to life far more than twice. In my case my life was saved with adrenaline aged 6 after anaphalactic shock & with penicillin for pneumonia in both lungs aged 12. My chances of surviving either without treatment were very slim.

  • rate this

    Comment number 260.

    Ernie - 257 There is reasonably good evidence that acupuncture IS effective for a number of medical conditions. These include headache. Check out


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