Medication Headache
Medication Overuse Headache

What is medication headache?

Medication headache is caused by taking painkillers too often for tension-type headaches or migraine. It is sometimes called medication overuse headache. It is a common cause of headaches that occur daily, or on most days. About 1 in 50 people develop this problem at some time in their life. It is five times more common in women than men.

The following is a typical case....

You may have a bad spell of tension headaches or migraines, perhaps during a time of stress. You take painkillers more often than usual. You continue doing this for a while. Therefore, your body becomes used to the painkillers. A 'rebound' or 'withdrawal' headache then develops if you do not take a painkiller within a day or so of the last dose. You think this is just another tension headache or migraine, and so you take a further dose of painkiller. When the effect of each dose of painkiller wears off, a further withdrawal headache develops, and so on.

A vicious circle develops. In time, you may have headaches on most days, or on every day, and you end up taking painkillers every day, or on most days. Some people start to take painkillers 'routinely' every day to try to prevent headaches. This only makes things worse.

The headache of medication headache is often described as 'oppressive' and tends to be worse first thing in the morning, or after exercise.

All of the common painkillers used to treat tension-type headaches or migraine can cause this problem. These include:

• Codeine.
• Paracetamol - especially if it is combined with codeine (for example, co-codamol).
• Anti-inflammatory painkillers such as aspirin, ibuprofen, naproxen, diclofenac, etc.
• Triptans used for migraine such as almotriptan, eletriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
• Ergotamine.

Note: Strictly speaking, triptans and ergotamine are not classed as painkillers. They work in a different way. However, they are used to treat migraine, and can cause medication headache.

What about taking painkillers for other conditions?

Medication headache does not seem to develop if you take painkillers for other painful conditions such as arthritis. It only occurs if you take painkillers for headaches or migraine. It is not clear why this is so.

The most important part of treatment is to recognise and understand the cause of your frequent headaches - the painkillers. You can then devise a plan to stop the painkillers. This is best done with the advice of a doctor.

You must stop the painkillers completely for a while to cure the problem. Do not take an alternative painkiller unless advised by a doctor (see below).

When you stop the painkillers, the headaches will get worse for a while. Some people also feel sick, become anxious, or sleep badly for a few days when the painkillers are first stopped. You will have to tolerate the headaches for a while, and other symptoms if they develop, until the painkillers are 'out of your system'. Your headaches should then gradually go back to a 'normal' frequency. This often takes 7-10 days. However, in some cases it takes weeks or months for the headaches to ease off after stopping the painkillers.

In some cases, if an anti-inflammatory painkiller is not the cause of the medication headache, then your doctor may advise a course of anti-inflammatory painkillers. This may ease headaches after stopping the causative painkiller. (This may sound illogical, but anti-inflammatory painkillers are in a different 'class' of drugs to other types of painkiller. So, it may be an option to use one as a treatment in some cases if your body is not used to anti-inflammatory painkillers.)

In some cases, if an anti-inflammatory painkiller is the cause of the medication headache, then your doctor may advise a course of amitriptyline. This is not a painkiller. It is an antidepressant medicine and you have to take it every day. (One effect of some antidepressants is to ease pain and prevent headaches even in people who are not depressed.) A low dose is started at first and may need to be increased over time. Once the headaches have gone back to a normal frequency the amitriptyline is stopped.

What about treating headaches in the future?

You can restart to use painkillers 'as required' when the pattern of your headaches returns to 'normal'. To prevent a recurrence of medication headache, as a general rule:

• You should not take painkillers for headache on more than 15 days in any month.
• It is OK to take three or four doses over a day or so, every now and then. However, do not take painkillers for two or more consecutive days for headaches, even if you get headaches on consecutive days.
• Codeine and tablets containing codeine such as co-codamol are best avoided altogether. They are more likely to cause medication headache than other painkillers.

You might have to decide not to treat some headaches, and just wait for them to go if you have already used up the recommended quota of painkillers in the previous few days.

See a doctor if frequent headaches do not go, or if they return again in the future.

© EMIS and PIP 2005   Updated: January 2005   Review Date: February 2006   CHIQ Accredited   PRODIGY Validated

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