HEALTH WATCH: Addictive painkillers causing headaches

By Dr Cory Couillard

Headache disorders are not perceived as serious since they are mostly episodic, do not cause death, and are not contagious, but they are extremely common and debilitating. Up to 75 per cent of adults aged 18 to 65 years have had a headache in the last year.

Experts agree that headache disorders are under-estimated, under-recognized and under-treated. Coincidently, only four hours of undergraduate medical education is dedicated to instruction of headache disorders. This results in a lack of public health knowledge, education and lifestyle modification.

Of those who treat, most are solely reliant on over-the-counter medications. However, over-the-counter medications have been found to be a cause of frequent or daily headaches. Taking painkillers too often for tension-type headaches or migraine attacks has been found to cause medication-overuse headaches (MOH).

MOH is the third most common cause of headache and about 1 person in 50 develops this problem. It can occur at any age but is most common in women in their 30's and 40's.

A vicious cycle often develops if you try to treat headaches with over-the-counter medications. One’s body becomes addicted to painkillers and a rebound or withdrawal headache develops if you do not take them. Often people are not aware and think this headache is just another tension headache or migraine, and unknowingly continue to feed the addiction.

Medication-overuse headaches tend to be worse in the morning, or after exercise. It may be a constant, dull headache with fluctuating degrees of severity. This results in people taking painkillers every day, or on most days. Even some people start taking painkillers early in the morning or late in the evening to try to prevent headaches from occurring, once again making it worse.

The amount of painkillers needed to cause a medication-overuse headache is not clear and it varies with different people and health conditions. All of the common medications used to treat headaches such as aspirin, ibuprofen, naproxen and diclofenac have been shown to have addictive and headache-producing qualities.

Triptans are not classified as painkillers but are commonly used in the treatment of migraine headaches. Medications such as almotriptan, eletriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan have all been associated with medication-overuse headaches.

It’s important to stop taking painkillers or triptans if you suspect that you have medication-overuse headaches. It is important not to take an alternative painkiller in attempt to beat the addiction or the headache. The best advice is to seek the guidance of a doctor.

When you quit, headaches are likely to get worse due to withdrawal symptoms and slowly improve over time. It often takes approximately a week but in some people it may take a few weeks to kick the habit. Withdrawal symptoms often include achiness, anxiety, nausea and sleep disturbances.

The best way to treat a headache is not to rely on medication that can cause it. Many types of lifestyle modifications have been shown to be as effective as certain over-the-counter medications. You can expect about a 55 per cent reduction in headache frequency, on average, with behavioural and lifestyle interventions.

According to research, the strongest link to many types of headaches is stress. Stress-reducing techniques, maintaining good-quality sleep and engaging in regular physical activity have been shown effective at reducing headaches.

Dr Cory Couillard is an international health columnist who works in collaboration with the World Health Organization's goals of disease prevention and global health care education. Views do not necessarily reflect endorsement.