Medication Overuse Headache
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Could your frequent headaches be due to medication overuse?
By Dr. Jud Pearson
Around 40% of patients attending the National Migraine Centre have issues with medication overuse headaches. It is the commonest cause of chronic daily headache. Migraine is known to be a genetic condition, and those with migraine genes are particularly susceptible to developing chronic headaches when painkilling medication is taken too frequently.
Medication overuse can occur in anyone using acute medication (painkillers or triptans,) to treat their symptoms on more than 2-3 days a week. Some patients have particularly long attacks of migraine, particularly around menstruation, which may need to be treated over 4 or 5 consecutive days, so we often average out the total number of days treated per month. If someone is using symptomatic treatment more than 12-15 days a month, the treatment itself may be affecting the frequency of headache. If this has occurred over three months or more, then the patient is likely to have medication overuse headache. It is more common with medicines containing codeine, such as cocodamol or migraleve, but it can even occur with seemingly innocuous treatments bought over the counter, such as aspirin, paracetamol or ibuprofen.
We recognise that taking treatment early in a migraine attack can be more effective than waiting for the migraine to peak before treating it, however, this can lead to patients taking medication too frequently “just in case” today’s mild headache escalates into this afternoon’s migraine. If you find that you are doing this often, then it may be time to seek medical advice before you develop medication overuse. It is very useful to keep a diary of symptoms and painkillers taken. The National Migraine Centre headache diary has been specifically designed to record this information. It can be downloaded from our website here. Download your monthly migraine diary here.
The chronic headache resulting from medication overuse is often described as “featureless,” a constant dull ache with migrainous exacerbations, and can be disabling. Patients have invariably had episodes of migraine in the past but the frequent medication use has blurred their symptoms into one long, chronic pain. This quickly becomes a vicious circle, whereby the patient has to keep taking medication just in order to continue to function. It is important to point out that medication overuse is a very common trap, but is nobody’s “fault.” Nor are patients “addicted” to painkillers, it is just that the body expects a tablet to deal with the pain rather than suppressing pain signals with natural endorphins.
The diagnosis is only certain after the medication has been withdrawn and there is an improvement in the headache pattern. It takes around six weeks to come off acute medication and to let the body return to its baseline headache pattern. During the first couple of weeks off painkillers, the headaches can be worse, but after this there can be a striking improvement. Little scientific study has gone into treating medication overuse headache, but the National Migraine Centre has years of experience in supporting patients as they come off acute medication. Your NMC doctor may recommend a course of a regular, long acting anti-inflammatory painkiller to reduce the symptoms as you withdraw from your other medications. Sometimes we use a daily preventative drug to do this. Botox is also licenced for the treatment of medication overuse headache, but has not been approved for use on the NHS for this indication. It is an option that you can discuss with your doctor at the NMC. It can feel like quite a leap of faith to stop taking painkillers altogether, but with the right support and information, the results are dramatic.
Things to remember about medication overuse:
It’s not the patient’s fault.
It’s not an addiction.
Prevention is better than cure.
Keeping a diary of how often you take medication is very useful.
Treatments are available and can have dramatic results.
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We wanted to say a big thank you to SCA Hygiene Products UK ltd who supported our charity this year and very kindly presented us with a £1,000 cheque to help us in our mission to treat all those that suffer from migraine. Their staff members also helped contribute a further £41 to our cause.
To show our appreciation to SCA Hygiene Products we did a presentation to their employees and gave them information about the National Migraine Centre and advice on migraine and headaches. During the presentation we were presented with the beautiful cake above!
We are truely thankful to SCA Hygiene Products for this donation.
If you work for an organisation that you feel would benefit from a talk from us or would like to make the National Migraine Centre their ‘Charity of the Year’ then please give us a call on 020 7251 7806.
Another big thank you to Grange Park School’s Year 7 who kindly held a cookie sale to raise funds for the National Migraine Centre. They raised a total of £92.82.
If you work for a school or have children that go to school and would like to hold a fundraising event for us then please do get in touch by calling 020 7251 7806 or emailing firstname.lastname@example.org.
Some of our patients have been kind enough to nominate the Clinic for a donation from corporate charitable trusts. Most large employers and many smaller ones support charities in a variety of ways; examples include payroll giving, matched funding-schemes and ‘Charity of the Year’- awards. If any of you are employees of a company which runs such a scheme please consider us.
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Alice’s story: how the National Migraine Centre’s doctors helped her
Alice talks about the expertise and sensitivity of the doctors at the National Migraine Centre and how they provided her with a tailored treatment plan.