People over the age of 40 are more likely to be affected by the issue
An NHS GP has warned people about taking common painkillers such as paracetamol for headaches – and explained that it can actually make it worse. Dr Mark Porter, an expert who has regularly appeared on Good Morning Britain and This Morning said that pain in the head can be from a lot of different causes.
He explained that the National Institute for Health and Care Excellence (Nice) has just updated its guidance on diagnosis and management to help GPs and their patients.
The doctor said that some of the advice related to serious illnesses such as meningitis or a brain tumour could be the ‘sinister’ cause. However a second piece of advice was about how headaches can actually be triggered by the pills people take to treat them.
Writing in The Times, he said: “Nice estimates that 1-2 per cent of the population have medication-overuse headache (MOH) — frequent headaches caused by painkillers and migraine treatments. That’s about a million people in the UK. Could you, or someone in your family, be one of them?
“MOH can affect anyone at any age but is most common among people in their forties. It starts when someone takes medication for an existing headache — typically migraine, but tension headaches too — then continues to do so regularly for the next few months. The definition of “regularly” depends on the medication: for migraine treatments such as sumatriptan and opioid-containing painkillers including codeine or codeine/paracetamol mixes (co-codamol), this means ten days or more a month; for others such as paracetamol, ibuprofen and aspirin, it means 15 days or more.”
Dr Porter said genetics could play a part meaning it could run in families and that it’s more common in women than in men, and in people with anxiety and depression. He added: “Interestingly we tend not to see similar persistent headaches in people who take these painkillers for other reasons, such as an arthritic hip or knee.
“Whatever the underlying cause, by the time most people seek help they will have been struggling with almost daily headaches for months. The nature, site and intensity will vary from person to person, but they tend to be worse in the morning. Painkillers help, but not for long, and the headache soon returns, perpetuating the cycle: the more painkillers you take, the worse the problem can become.”
In order to eliminate other causes Dr Porter said people first need to stop taking the migraine treatments and/or painkillers. He said: “Some people may require weaning, depending on the type of medication and doses involved, but Nice advocates abrupt withdrawal for most. This can be a hard sell because typically it takes at least two weeks for the headaches to start to improve, with full recovery often taking two to three months. For those who struggle, the difficult initial period of cold turkey can be eased using preventive medication such as amitriptyline.
”And, talking of prevention, this is a condition that should be avoidable. If you are having regular headaches, such as migraines, then seek help early rather than self-medicating. And don’t take over-the-counter codeine-based painkillers for frequent headaches because they are more likely to trigger MOH than simple paracetamol and ibuprofen.”
Nice advises that the following symptoms warrant further investigation or referral in people with headache:
• Any worsening in pain associated with a high temperature.
• Sudden onset (reaching maximum intensity within five minutes).
• New weakness, altered sensation, confusion or a change in personality.
• Impaired consciousness.
• Recent head trauma (eg within the past three months).
• Headache aggravated by coughing, sneezing, exercise or changes in posture.
• Accompanying tenderness over the temples, jaw-ache during eating, and/or visual disturbance (excluding typical migraine aura).
• Any substantial change in the type or severity of the headache.
