Headaches and painkillers

Painkillers - cure or curse?

The phenomenon of "medication overuse headaches" has been observed by neurologists for many years. But the health watchdog NICE believes that far too few patients and GPs realise the harm that it causes.

NICE has issued new guidance to health professionals in England and Wales, but the advice could equally apply to doctors across the UK and indeed globally. The hope is it will raise awareness of a problem that blights the lives of huge numbers.

Just how many people are affected is unclear. There is very limited research on the scale of the problem. A German study from (Katsarava, Current Neurology and Neuroscience Reports 2009, 9: 115-119) suggested it may affect up to four percent of the population. The specialists who drew up the NICE guidance settle for up to two percent or 1 in 50 people.

It is perhaps commonsense that taking too much of any medication maybe harmful. But neurologists are unclear exactly why overuse of painkillers causes more headaches. Somehow the medication disrupts the balance of the body's own pain control system.

Cold turkey

The treatment is rather brutal. The abrupt halting of all the suspect painkillers for at least a month.

That's what Fran Swaine went through. She has suffered migraines for years and did not realise she had been taking far too many painkillers, and that these were making the problem worse. "After six weeks of going cold turkey I was able to take my medication again and I noticed it actually worked. It means migraines are no longer ruling my life."

So how much is too much? GPs are being advised to be alert to the possibility of medication overuse headache in people whose symptoms have worsened after taking the following drugs for three months or more:

Triptans, opioids, ergots or combination analgesic medications on 10 days a month or more or paracetamol, aspirin or an NSAID (anti-inflammatory such as ibuprofen) on 15 days a month or more.

There are of course many different types of headache. We have all suffered the common tension headache. Far worse are migraines and cluster headaches which can be completely debilitating. One sufferer of cluster headaches said it was like having a red-hot poker shoved in his eye.

The playwright George Bernard Shaw suffered badly with headaches, and on meeting the artic explorer Friedjof Nansen said: "You have spent your life in trying to discover the North Pole, which nobody on earth cares tuppence about, and you have never attempt to discover a cure for the headache, which every living person is crying aloud for."