Painkillers May Lead To More Headaches, Trapping People In A “Vicious Cycle”

Lawrence LeBlond for – Your Universe Online

Painful headaches that affect nearly a million people in the UK, and many more millions worldwide, may be partly caused by overuse of common painkillers such as aspirin, paracetamol and triptans, according to the National Institute for Health and Clinical Excellence (NICE). The watchdog estimates that one in 50 people who experience headaches are suffering because they overuse their medications.

The warning comes as the group, funded by the UK government since 2009, releases its first guideline for doctors in England and Wales on diagnosing and managing headaches. The report states that up to a million people in the UK have “completely preventable” severe headaches caused by taking too many pain pills. Some of these people are trapped in a “vicious cycle” of taking pills for pain relief, which then cause more headaches, to which they then take more pills to try to stop the headaches.

Headaches caused by medication overuse feel the same as other common headaches and migraines, the group said.

“We have effective treatments for common headache types,” said Martin Underwood, a general practitioner and professor of primary care research at Warwick Medical School. “However, taking these medicines for more than 10 or 15 days a month can cause medication overuse headache, which is a disabling and preventable disorder.”

Underwood said he hopes the new guideline will help “improve awareness of medication overuse headache both in primary care and among the general public because prevention is simple and treatment is difficult.” He noted that “explaining to patients that they should abruptly stop their medication, knowing that their headache will get much worse for several weeks before it will improve, is not an easy consultation.”

The UK has no authoritative data on the incidence of headache from medication overuse, but studies in other countries have shown 1 to 2 percent of people are affected; the World Health Organization (WHO) has put that estimate closer to 5 percent.

Experts do not know exactly why painkillers have this effect on the brain. Most people affected are believed to have had previous tension-type headaches or migraines occurring on a daily basis. And then these headaches became worse as people treated themselves at home with medication.

Manjit Matharu, a consultant neurologist at the National Hospital for Neurology and Neurosurgery, told BBC News that medication overuse was a “huge problem” in the population.

People with a family history of tension-type headaches or migraines 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.

NICE said it recommends other options such as acupuncture as a means of treatment in some circumstances.

“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,” Underwood said.

NICE also urges doctors to not jump the gun and refer patients for brain scans “solely for reassurance” that they do not have a tumor. The panel said a tumor would come with other symptoms such as a change in behavior or epilepsy.

“The guideline will assist with accurate diagnosis, appropriate referral and evidence-based information for those with troublesome and disabling headaches,” said Wendy Thomas, chief executive of the Migraine Trust. “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,” she added.

“Headache is the most prevalent condition and one in seven of the UK population has migraine,” Dr Fayyaz Ahmed, the chair of British Association for the Study of Headache, who welcomed the study, told BBC News´ James Gallagher. “The condition puts an enormous burden on the healthcare resources and the economy in general.”

“Although headache is the most common neurological problem seen by GPs and neurologists, many people are not receiving correct or timely diagnoses,” said Dr. Gillian Leng, deputy chief executive of NICE. “Our guideline outlines the assessments and treatments that people should expect to receive for primary headaches and medication overuse. We hope that this will help GPs and other healthcare professionals to correctly diagnose the type of headache disorder and better recognize patients whose headaches could be caused by their over-reliance on medications.”

The NICE guideline was developed with the help of Peter May, a long-time headache sufferer who was initially told by doctors that he was suffering from migraines.

“The pain I experience in an attack lasts around 45 minutes to an hour, and is excruciating, like being stabbed in my eye with a red hot poker,” he explained. “It took two years for me to receive a correct diagnosis, but I believe I am one of the fortunate ones as I know people who have gone 20 years” before receiving a correct diagnosis.

“There are effective treatments available but they differ according to the type of headache and so having a correct diagnosis as soon as possible is crucial,” he added.