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 379.

    "There is no definitive UK data on the incidence of the condition"

    So why wast a page reporting on it ?

  • rate this

    Comment number 378.

    Paracetamol are crap anyway - people take them for headaches - and it just sits there like a scabby dog with no home to go to; this report is hardly newsworthy. "Paracetamol don't cure headaches" is a bit like saying "Standing on one leg, with a mangle attached to your head with barbed wire won't cure headaches, it will bring them on"

  • rate this

    Comment number 377.

    My "common" headaches are usually due to lack of water, caffeine or rest and are easily banished. I do get migraines that first show as visual effects ( sparkly edged blind spot ). I've found that eating something immediately will prevent onset. Otherwise, I'm off for 2-3 days bed rest in the quiet dark. But, aside from the low dose heart regimen, I don't keep any painkillers in the house.

  • rate this

    Comment number 376.

    I know people that take painkillers for back, neck & other muscular ailments, so are these kind of pains going to join the vicious circle of rebound pain in all these regions from taking daily amount of painkillers? And I see you'd have to maybe go into hospital for the cold turkey (no, not the bird) because you might end up worse suddenly stopping taking them. Oh & doctors are to blame as well!

  • rate this

    Comment number 375.

    The guidelines are blindingly simple, don't take more than the stated dose. Reading some of these comments makes me wonder how some people actually survive outside the womb.

  • rate this

    Comment number 374.

    I am really not surprised. A few years ago I took painkillers for about a week to treat earache, the earache went away and so I stopped taking the painkillers.The next day I had a headache and nearly took another painkiller till I realised that that was probably what was causing the pain.

  • rate this

    Comment number 373.

    In this day and age I am surprised that there is not a better range of pain relief available that we have now. I was incredulous at how small the options really are when I was diagnosed with cancer. I am extra sensitive to opiates (from which I have serious side effects way worse than just headaches), and there is not much else available.

  • rate this

    Comment number 372.

    I can see why some people don't even bother to go the doctor if they are in pain. Because the GPs that I met are likely to not bother investigating the cause and send you home with a painkiller preciption instead!

  • rate this

    Comment number 371.

    My partners doctor tells him to take paracetamol every day for the pain of his arthritis!
    So now what?

    parecetamol is not suitable for arthritis, arthritis (all types) are inflammatory illnesses but paracetamol has neglible anti-inflammatory effect, ibuprofin & aspirin are much better though aspirin if taken regularly it needs to be in coated form to prevent risk of ulcers.

  • rate this

    Comment number 370.

    "There is reasonably good evidence that acupuncture IS effective for a number of medical conditions. These include headache. Check out >nhs link>"

    Inexplicably you forgot to note:
    "However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions"

  • rate this

    Comment number 369.

    In re to fibromyalgia - couple of years ago found out I am allergic to something in or on grapes. The symptom was joint and muscle pain - worse when I ate a bunch of green grapes. Aspirin did not get rid of the pain. When I removed all products with grapes from my diet - pain went away. So much for health foods. This also explains why I can't stand the taste of wine.

  • rate this

    Comment number 368.

    # 347 Simple solution,use a different chemist till you find one that does,nt play 20 questions every time you get your prescription.

  • rate this

    Comment number 367.

    this is really aimed at people popping pills for headaches & migrane (many claim migrane when its not) rather than people with illnesses of types described by some previous posters. I find people are often too quick to reach for the pills & often take the wrong pill for minor one-off issues (TV pill adverts dont help). They can then get in a cycle of recurring headaches caused by the pill popping

  • rate this

    Comment number 366.

    Cardinal rule: Everything on moderation, including medicines!

  • rate this

    Comment number 365.

    It is nice to know that a website exists that allows people to Have their Say.
    But it does fall down in one respect.
    The topic is picked for them.Not by them.
    In other words feel free to join the debate.
    But do not expect any choice on the subject,up for debate.

  • rate this

    Comment number 364.

    What do the doctors want us to do then? Suffer in silence and we cannot get through the day? Of course we have to take the pain killers to ease the headache. Why do you suffer unnecessarily? This is another myth similar to antidepressants. Doctors insist that these pills do not promote weight gain whereas patients complain that they balloon in weight like I did. Syndol is best for headaches folks.

  • Comment number 363.

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

  • rate this

    Comment number 362.

    I used to get headaches and migraine very regularly for years and then when I started taking a multivitamin/ mineral tablet every day they gradually subsided. When I stopped taking the tablets they came back only to disappear again on restarting. I think its possibly the magnesium and it certainly seems to work for me.

  • rate this

    Comment number 361.

    Unfortunately, doctors cannot cure everything. Many patients are unhappy with this truth. But you have to accept it. For some patients headaches cannot be cured. I have had severe lower back pain for decades despite a lot of time spent trying to define the problem. Likewise, I have to accept this and have learned to live with it.

  • rate this

    Comment number 360.

    Pain medications are made from opiates. James should do some research before he presents this obtuse observation.


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