Experts say pills people take to relieve headaches and migraines may be making things much worse. More than one million people in Britain may be suffering from constant, crippling headaches because they are taking too many painkillers, experts say.
The pills people take to relieve headaches and migraines may be making things much worse, according to the National Institute for Health and Clinical Excellence (Nice) in guidance to the health service for England and Wales.
As many as one in 50 people suffering from continual headaches are in fact victims of “medication overuse,” Nice reports.
The problem begins with taking the odd painkiller for tension headaches or migraines, which usually works. But some people take the pills more and more often, until they are on tablets for more than half the days in a month. Nice says that if this goes on for more than three months the medication ends up causing the problem it is intended to cure.
“Patients with frequent tension-type headaches or migraines can get themselves into a vicious cycle, where their headaches are getting increasingly worse, so they take more medication which makes their pain even worse,” said Martin Underwood, a GP and professor of primary care research at Warwick medical school, who chaired the guideline development group.
At risk are those who are taking paracetamol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, for their headaches, either alone or in combination, for 15 days a month or more.
The risk is also carried by migraine sufferers taking triptans, opioids, ergots or combination analgesic medications for just 10 days a month or more.
The solution is far from easy. Manjit Matharu, honorary consultant neurologist at the National Hospital for Neurology and Neurosurgery, said people needed to stop taking the painkillers abruptly.
“For the first two to three weeks, they are likely to have a severe rebound. They will have an awful two to three weeks. Patients understandably worry about how they are going to feel in the middle of a withdrawal,” he said.
“What I do is make sure that anybody who is going through a withdrawal and [who] I know will be in a huge amount of pain does not have the usual responsibilities.” He will write sick notes to excuse people from work and call relatives to make sure there is support.
“We find if we do this, in a supportive manner, it is quite successful, 80 per cent of patients successfully do it when you outline to them that there is an awful phase but you will feel much better after it.”
Nice also advises GPs not to send their headache patients for brain scans just for reassurance. It says that there is no reason to suspect a brain tumour without other specific “red flag” symptoms, such as behavioural changes, and that the reassurance did not last if the headaches were not properly managed.
More than 10 million people in the UK have regular or frequent headaches, which account for one in 25 consultations with a GP. Migraines are responsible for 100,000 people being absent from work or school every day.
Nice said it was important for doctors to diagnose what sort of headaches people were experiencing such as tension headaches, cluster headaches and migraines and treat them appropriately.
The guidelines recommend specific drugs for each condition, together with measures that can be taken to prevent some of the headaches occurring.
Guardian News and Media 2012