If you suffer from frequent headaches, this blog about medication-overuse headache is important to read and understand!!
Take home message – If you are using any acute headache medications more than 1-2 times per week, you are at risk of developing medication-overuse headache.
What is medication-overuse headache?
It is a daily headache that is directly related to overuse of headache medication. It is responsible for most of recurrent daily headaches and the majority of referrals to headache specialists.
Simply put, overuse of medication designed to help out with headaches can make the situation worse. A lot worse.
Medication-overuse headache used to be known as rebound headache, withdrawal headache, analgesic rebound headache or drug-induced headache.
Which medications are involved?
The surprising thing is that the medications that are associated with medication-overuse headache aren’t only the obvious ones, like stronger medications containing codeine (though codeine-based medications have a particularly strong association with medication-overuse headache developing).
It also involves
- simple analgesia (eg paracetamol),
- triptans (eg Imigran, Zomig, Naramig, Maxalt, Relpax),
- combination analgesia (eg Endone, Mersyndol, Panadeine Forte) and
- caffeine-containing medications (eg Panadeine Extra)
So how often is too often?
According to Headache Australia, ‘too often’ is using these medications more than 2-3 days per week. This level of usage is particularly common in the headache and migraine population.
Does this sound like you?
The story will often be that someone starts with the occasional headache, and two Panadol worked quite well and the headache went in a couple of hours.
The headaches became more frequent. The medication frequency and amount increased to control the pain, but didn’t seem to work as well.
Then at some point the headaches become daily and are usually there when you wake up in the morning.
On top of that, there are flare-ups with attacks of bad headaches.
There is probably an underlying feeling that if you don’t take the medication every day, a severe headache is inevitable.
However, the medication doesn’t really help much any more and if it gives any help, it is short-lived only.
If this sounds like you, you are not alone!
It is actually quite common, with up to 70% of patients in specialised clinics being affected and a staggering 1-3% of the population (Williams, 2005, Andrassik et al, 2010).
Why is it so important that you don’t overuse any medication?
Medication overuse is a big risk factor for the development of chronic headaches. Relapse rate is high in Medication-Overuse Headache even if treated. Overuse of any of these acute medications often make someone less responsive to other acute and preventative treatments.
In short, it becomes a vicious cycle.
In Part Two of this blog, I will describe the treatment of Medication-Overuse Headache, including the role of your GP and physiotherapy – click here to see part 2.
References:
Andrassik F, Grazzi L, Usai S, Kass S, Bussonee G. Disability in chronic migraine with medication overuse: Treatment effects through 5 years. Cephalalgia 2010;30:610-614
Krymchantowski AV. A Short Review on Medication-Overuse Headache. International Journal of Rehabilitation. 2017; 4:484
Williams, D. Medication Overuse Headache. Australian Prescriber 2005;28:59-62
Sun-Edlestein C. Medication Overuse Headache. http://headacheaustralia.org.au/headachetypes/medication-overuse-headache/
