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.
So the tablets you take to relieve that awful headache may well be just making matters worse.
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.
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. (Bear in mind that long term use of paracetamol and NSAIDs also increases the risk of developing Alzheimer’s disease).
The risk of increasing the number of headaches or migraines is also carried by migraine sufferers taking triptans, opioids, ergots or combination analgesic medications for just 10 days a month or more.
“It may get worse before it gets better”
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 completely.
"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% of patients successfully do it when you outline to them that there is an awful phase but you will feel much better after it."
What’s the alternative? Acupuncture is good, says NICE
The NICE guidelines on the management of headache published in September are a little confusing in that having recommended patients stop their medication and analgesics, doctors should then prescribe analgesics, such as NSAIDs, and triptans!
One positive statement though is that patients should be offered a course of acupuncture for tension type headaches. They recommend up to 10 treatments but our clinical experience has been that usually 5 or 6 treatments are enough.
The guidelines only talk of acupuncture for tension type headache, but our clinical experience,again, has been that it is very effective for migraines and hormonal and period related headaches too. There has been a very large study in Germany which showed the benefit of acupuncture for migraine and there was a British study demonstrating that acupuncture was more effective than conventional treatment, which was actually carried out at the National Hospital for Nervous Diseases (as it was then).
Other ways - exercise and osteopathy
Regular gentle exercise - yoga, pilates, swimming and walking, will almost certainly help to reduce tension type headaches. Many headaches are due to problems in the neck and these may well be helped by gentle osteopathy which looks to find the areas of tension and stiffness and then to relieve them by achieving more mobility and flexibility.
NB Any persistent or sudden severe headache should always be checked by your doctor first.