No fast cure

TAKING medicines like painkillers over a prolonged period of time to relieve headaches can actually make symptoms worse, according to the latest guidelines from NICE, the British National Institute for Clinical Excellence.

NICE, provider of guidance for GPs and other health professionals in Britain, warns that ‘medication overuse headaches’ are a possible cause for worsening symptoms among patients who have been taking such drugs up to 15 days per month, for three months or more.

Martin Underwood, GP and chair of NICE’s guideline development group said: “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.”

The new guidelines outline the assessments and treatments for primary headaches and medication overuse, which ‘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’, according to Dr Gillian Leng, deputy chief executive of NICE.

“The current advice is the same for Ireland as in Britain,” according to Dr John Ball, of the Irish College of General Practitioners. “The ICGP would always recommend review of someone who is on painkillers for a prolonged time for headache.”

What Dr Ball terms ‘analgesia-induced headache’ has been known about for some time and would be in the ‘differential diagnosis for anyone with chronic headaches’.

According to the Migraine Association of Ireland, ‘more than 60% of patients attending Irish migraine/ headache clinics are suffering from medication overuse headache’, a condition which, they say, affects more women than men, by a ratio of between 3:1 and 5:1.

“Paracetamol and aspirin are over-the-counter medicines, and are safe and effective when used in accordance with the instructions and on the advice of a pharmacist,” according to the Irish Pharmacy Union (IPU).

“The vast majority of people using these medicines do so safely and correctly,” says IPU spokesperson.

The Union points to its awareness campaigns advising on the safe use of pain relievers which highlight the problems associated with overuse or abuse. The British Association for the Study of Headache recommend, amongst other things, patient education, withdrawal of the offending drug and psychological support along with a good diet, regular exercise, maintaining hydration, and relaxation techniques during withdrawal.