Headaches from too much pain relief
If you are a frequent headache sufferer, and you take pain relief to treat your headaches on a regular basis, then it is worth talking to your GP about it.
Iam a headache sufferer. Unfortunately this seems to be a family trait, with my mother, sisters and now both my daughters all affected too. It doesn’t impact hugely on my life now, but for years when I had regular migraines it felt hard to function at full capacity, and I lived off paracetamol and ibuprofen, especially on the days I had to work.
I now know that perhaps the amount of pain relief medication I was taking was actually exacerbating the problem rather than helping it as intended. There is a condition known as medication-overuse headache (or medication-induced headache) that has become well recognised over the past decade or so.
In fact, it is thought to be the third-most common cause of regular headaches, after migraines and tension headaches.
About one in 50 people will suffer from this type of headache, and it typically affects those in their 30s and 40s, women more than men. It is caused by the regular use of analgesia (pain relief), and only seems to be an issue when people are using these medications to treat headaches – if you are regularly taking pain relief to treat other conditions such as arthritis or back issues for example, this doesn’t seem to be a risk.
Quite why this is, I don’t think we fully understand, but it could be something to do with sensitising the pain receptors associated with headaches in particular.
The symptoms and background associated with medicationoveruse headache (MOH) are:
❚ A history of pre-existing, regular headaches over a long period (eg, migraines or tension headaches).
❚ Frequent use of analgesia to treat these headaches – several times a month, over several months in a row. ❚ Subsequent onset of daily, often constant headaches – usually described as a ‘‘dull’’ pain, rather than the sharp, stabbing pains associated with migraines; these headaches can be debilitating.
❚ Sufferers may be able to recognise these headaches as different from the original ones, but this is not always the case – they may simply think their ‘‘usual’’ headaches are getting worse or more frequent, and may increase their use of pain relieving medications.
Some types of pain relief seem to be more associated with the development of MOH than others – the top culprits are codeine or opiate-based medications (such as codeine, dihydrocodeine, combination products such as paracodeine, and morphine-based substances), and a group of drugs known as ‘‘triptans’’ which are used to treat migraines.
It is thought that regular usage of these drugs, exceeding 10 days a month, is enough to lead to MOH.
Other types of analgesia including non-steroidals (such as ibuprofen, Voltaren or naproxen) and paracetamol, can also lead to MOH but the threshold seems to be a little higher – it is thought that usage for 15 or more days a month is in the risky level, but lower than that appears to be well-tolerated.
Figuring out that MOH is the cause of your headaches is the first step towards managing them.
If you are a frequent headache sufferer, and you take pain relief to treat your headaches on a regular basis, then it is worth considering this and talking to your GP about it.
Your doctor will be able to look at your medication and suggest you reduce your usage a bit and see what happens to the headaches – if they decrease when you do this, then MOH is likely the diagnosis.
If they don’t, then your doctor will need to do further assessment to exclude other underlying conditions.
Once you have worked out that MOH may be part of the problem, managing your pain relief so that you fall under the threshold for ‘‘safe’’ usage (ie, less than 10 or 15 days a month, depending on the drug) is the first step. It doesn’t mean you can’t use pain relief at all, but it does mean you need to minimise it.
The next step is to discuss ongoing management for your underlying, original headache problem, be it migraines, tension headaches or something else – unfortunately these won’t go away when you stop the pain relief as the MOH headaches will.
There are plenty of good ‘‘preventer’’ medicines available now that can be taken regularly and are effective at reducing the frequency and intensity of headaches, as well as exploring other complementary options such as physio, massage, yoga, and acupuncture.
❚ Dr Cathy Stephenson is a GP and forensic medical examiner.