National Institute for Health and Clinical Excellence (NICE)
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Overuse of painkillers can make headaches worse
Taking medicines such as painkillers over a prolonged period of time to relieve headaches can actually make symptoms worse, according to latest guidelines from NICE.
Headaches are one of the most common complaints presented to GPs and neurologists, with more than 10 million people in the UK experiencing them frequently or at regular intervals.
Many people who suffer from headaches choose to treat them with over-the-counter medicines such as paracetamol, aspirin or triptans.
However, up to 1 in 50 people experience headaches that result from using these treatments frequently.
NICE's first clinical guideline on headaches says GP and other healthcare professionals should consider ‘medication overuse headaches' as a possible cause for worsening symptoms among patients who have been taking such drugs for three months or more.
It defines medication overuse headaches as when certain drugs are taken up to 15 days per month for three months or more.
These drugs include triptans, opioids, ergots or combination analgesic medications on 10 days per month or more; or paracetamol, aspirin or a non-steroid anti-inflammatory drug, either alone or any combination, on 15 days per month or more.
While there are around 200 distinct types of headache, 95 per cent of headaches are due to four types of treatable disorders, namely tension-type headaches, migraines, cluster headaches, and medication overuse headaches.
The guideline focuses on these four common headache disorders, and aims to improve treatment by providing healthcare professionals with guidance on accurate diagnosis of each type.
Tension-type headaches cause a pressing or tightening, non-pulsating pain of mild or moderate in intensity that is not affected by routine activities of daily living.
Migraine is a pulsating pain, that is throbbing or banging in young people aged between 12 and 17, and that is moderate or severe in pain intensity.
Migraine is also aggravated by routine activities of daily living.
Cluster headache causes bouts of up to 8 headaches per day, with variable pain that is of severe or very severe intensity.
The guideline includes a table with information on the symptoms of each of these types of headaches, offering healthcare professionals information that is easy to refer to for diagnosis.
Martin Underwood, a GP and professor of primary care research at Warwick Medical School and chair of the guideline development group responsible for the guideline, said: “We have effective treatments for common headache types. However, taking these medicines for more than ten or fifteen days a month can cause medication overuse headache, which is a disabling and preventable disorder.
“Patients with frequent tension-type headaches or migraines can get themselves into a vicious cycle, where their headaches are getting increasingly worse, so they take more medication which makes their pain even worse as they take more medication.
Dr Gillian Leng, Deputy Chief Executive of NICE added: “Our guideline outlines the assessments and treatments that people should expect to receive for primary headaches and medication overuse.
“We hope that this will help GPs and other healthcare professionals to correctly diagnose the type of headache disorder and better recognise patients whose headaches could be caused by their over-reliance on medications.”
The guideline also recommends that for all headache disorders, GPs and other healthcare professionals should not refer people diagnosed with tension-type headache, migraine, cluster headache or medication overuse headache for neuroimaging solely for reassurance.
Manjit Matharu, Honorary Consultant Neurologist at the National Hospital for Neurology and Neurosurgery and member of the guideline development group, said this “will enable healthcare professionals to undertake investigations confidently while avoiding the need for unnecessary brain scans”.
He added: “Clearly, neuroimaging is still an important diagnostic tool, but most peoples' headaches will not be caused by brain tumours or other serious health problems, and so these should not be offered to patients solely for reassurance.”
A range of implementation tools have been produced to help support the use of this guideline.
Click here to listen to a podcast with Professor Underwood on the guideline recommendations and impact they have on general practice.