Medication Overuse Headache

However, the more up to date way of thinking is to regard the overuse of painkillers as part of a wider problem of chronic migraine.

The reason for this is that some people will be told that their headache are due to overuse of painkillers, but when they withdraw the painkillers, their headaches continue.

This causes confusion and can lead to a lack of trust between patient and health professionals!

Medication overuse is an easy target when trying to treat chronic migraine, but is not always the whole issue.

This problem of headaches following use of painkillers does seem unique to people with migraine.

For example when painkillers are given long term to people with arthritis, about 7% will develop daily headaches.

When you look at those 7% in detail you find that they all have a past history of migraine. The 93% with arthritis and NO history of migraine did not develop daily headaches.

It took an average of 5 years of painkiller use before headaches began to become a problem in these people with arthritis.

There is probably something unique about the brains of people with migraine that makes them prone to medication overuse headache.

How many painkillers does it take to cause Medication Overuse Headache?

Other studies have suggested that the following limits to reduce the risk of changing from normal migraine into a chronic medictaion overuse headache problem:

• Ordinary Painkillers
• For example - paracetamol / acetaminophen. No more than 5 times per week
• Triptans, Caffeine or Barbiturates
• No more than 3 times per week
• Ergotamine or codeine or other opioids
• No more than 2 times per week

Taking any of these drugs more often than that puts you at risk of chronic headaches.

One estimate suggested that more than 8 days per month of exposure to opiates increased the risk of chronic daily headache 13 times!

What to Expect on Stopping Medications

Many studies have looked at this in detail and a range of figures result:

1. One study of 216 people with migraine or tension-type headache found that 67% of those with migraine and 37% of those with a mixture of migraine and tension-type headache had a reduced headache frequency and intensity after 2 months.

   Those with ongoing headache found that they were more likely to respond to standard painkillers once more - that is they started to respond to treatment once more.

2. One study from the 1990's, asked people to stop offending medicines and gave training in biofeedback methods.

   People who continued the painkillers had a 21% improvement, compared to 58% who withdrew medication, and 85% who withdrew medication AND started migraine prophylaxis.

   Stopping the medication is important!

3. Longterm follow-up suggests that 87% people who can detoxify themselves and stay off any offending medication will remain without daily headache at 2 years of follow-up.
4. Staying off medication is very difficult.

   An Italian study followed 90 people for 5 years and found that only 40% managed to remain off painkillers.

   The headache intensity of those who remained off painkillers was a lot less than those who continued them

I've stopped my medications but I've still got the headaches - what now?

What do I mean by that?

Well if you have TRUE medication overuse problem, the headache will resolve when painkillers are stopped.

If you are diagnosed with medication-overuse-headaches and you continue to have headaches after stopping the painkillers, then you will usually think that your doctor does not know what they are doing!

That is why I think it is better to look at medication overuse as part of a wider headache issue. It is just one of the issues that you can take control of, and hopefully increase the chance in having a better quality of life.

There are people who will continue to have headaches despite having put in the effort to stop painkillers.

In this situation you need to make sure you have a confirmed headache diagnosis, and the most common one in this setting is chronic migraine.

It will also be helpful to make sure that a "secondary headache" has been considered and excluded too.

If the diagnosis remains chronic migraine, then you then need to follow a treatment programme for chronic migraine under medical supervision.

This may include trying combinations of preventative medication, targetted use of painkillers and a headache friendly lifestyle.

Some people with chronic headaches will even try psychological treatments for their headaches. Biofeedback techniques can also help reduce dependency on painkillers.

They key thing is to try and stop letting headaches run your life, and start to turn things round so that you run your own life, albeit with the intrusion of headaches.

The situation of continued chronic migraine in spite of best lifestyle, avoidance of painkillers and use of migraine prophylaxis is a very difficult one to manage.



Medication Overuse Headache is just one part of managing Chronic Migraine

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