Medication overuse headache
If you suffer from regular migraine or tension-type headaches you can find yourself in a vicious cycle. This is because if you try to treat these headaches with medicines on every occasion, you can develop a condition known as medication overuse headache.
Medication overuse headache is a form of chronic daily headache, brought on by the daily, or near daily, use of pain-relief medicine. (It seems that taking low doses of pain relievers daily carries greater risk of developing medication overuse headache than taking larger doses less frequently.) About 1 in 50 adults are thought to suffer from medication overuse headache.
Medication overuse headache can result from overuse (defined as taking on 10 or more days a month for 3 months) of triptans. However, this type of headache is much more likely to develop in people who take simple pain relievers — such as aspirin or paracetamol — regularly. People who consume paracetamol, aspirin or ibuprofen on 15 or more days a month for 3 months, put themselves at risk of medication overuse headache.
When pain relievers are combined with either codeine or caffeine, both of which have addictive properties, the risk of medication overuse headache increases. Pain relievers containing codeine or caffeine should not be consumed on more than 10 days each month, or, in the case of codeine, preferably avoided altogether.
Interestingly, medication overuse headache rarely develops in people who regularly take pain relievers for other conditions, such as arthritis.
If you experience regular — almost daily — headaches, that no longer respond to your usual pain relievers, talk to your doctor about the possibility of medication overuse headache. He or she may ask you to complete a headache diary to help with the diagnosis.
Management of medication overuse headache is difficult and generally requires specialist referral. For treatment to be successful, it’s necessary to completely withdraw from the ‘offending’ pain reliever, which is usually followed by a period of worsening symptoms. Other medicines can be prescribed to manage pain during this period.
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- British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. www.bash.org.uk (accessed 13 December 2011)
- Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
- International Headache Society. IHS Classification ICHD-II. London: IHS, 2004. ihs-classification.org/en/02_klassifikation (accessed 13 December 2011)
- Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.