The vicious circle of medication overuse does not strike patients at random, according to Professor Knut Hagen at NTNU. (Photo: Mike Schröder, NTB Scanpix)
The vicious circle of medication overuse does not strike patients at random, according to Professor Knut Hagen at NTNU. (Photo: Mike Schröder, NTB Scanpix)

Getting rid of headaches by cutting out headache pills

Half of all people with chronic headaches can be getting their throbbing heads from over-use of pain-relievers. This means many can get much relief very easily.

Nearly everyone gets a headache now and then. But about three to four percent of us suffer them frequently enough to be diagnosed with chronic headaches. A main reason for a throbbing headache several times a week can be frequent and wrong use of painkillers, both the over-the-counter type and the stronger, prescription pills and capsules.

This summer, Espen Saxhaug Kristoffersen of the University of Oslo (UiO) was honoured with a prize from the European Academy of Neurology for a presentation of the initial results from a new project on headaches.

Fewer aches

This is a follow-up of a study by Kristoffersen and colleagues which led to his PhD in 2014.

The study was led by Akershus University Hospital in collaboration with UiO’s Department of General Practice.

Espen Saxhaug Kristoffersen advises against taking painkillers for headaches more than twice a week. (Photo: UiO)
Espen Saxhaug Kristoffersen advises against taking painkillers for headaches more than twice a week. (Photo: UiO)

Fifty general practitioners (GPs) and their patients participated.

The preliminary results of the new project seem to confirm the findings from the doctoral study – about half of all patients could discernibly reduce their headaches if they cut down on or completely stopped taking pain-relief medication. The effect lasts a long time after they get treated for the over-use.

Vicious circle

“Lots of people use headache tablets on a daily basis. This becomes a vicious circle.”

If you tend to have many headaches and routinely take analgesics to keep the pain from starting, these painkillers can eventually start giving you headaches.

Knut Hagen is a headache specialist at NTNU. He thinks family doctors don’t know enough about the problems with painkillers. (Photo: NTNU)
Knut Hagen is a headache specialist at NTNU. He thinks family doctors don’t know enough about the problems with painkillers. (Photo: NTNU)

“Most of us are not aware that it can be harmful to liberally use headache medications,” claims Saxhaug Kristoffersen.

He thinks we should limit use of painkillers for headaches to no more than twice a week.

Easy to treat

The good news is that it is easy to treat headaches caused by medication over-use.

Chronic headaches are such a common public ailment that most victims treat themselves with pain-relief pills or tablets without contacting their family doctor. It’s a problem when GPs lack an overview of all the non-prescription, over-the-counter drugs that are being used.

In addition, many people use alternatives, such as nutritional supplements or homeopathic preparations, without the knowledge of their GPs. Moreover, many don’t even visit their GPs at all. 

“We know that about 20 percent of those who suffer headaches more than half the days in a year never contact their doctor about headaches,” says Saxhaug Kristoffersen.

Five easy questions

In their study, Saxhaug Kristoffersen and colleagues got GPs to talk to their patients about headaches.

“The general practitioners were given a short questionnaire consisting of five questions which would reveal whether the patient used too many medications. The patients were also informed of the advantages of cutting down on their use of these pills. The goal was to get them to take the medications no more frequently than two days a week.”

All this was done in the course of a normal consultation. The results were surprising.

“The patients were evaluated and followed up after three months. It turned out that half the patients had been releived of their chronic headaches. We have now followed up these patients for some time and the results look promising.”

Family doctors are insufficiently aware

Professor Knut Hagen at the Norwegian University of Science and Technology (NTNU) is connected to the Norwegian Advisory Unit on Headaches. He finds Kristoffersen’s study intriguing.

“It’s fascinating that just a relatively easy measure is all that is needed to treat chronic headaches. It’s great if they can be treated by the general practitioners, which reduces the need for referrals to specialists.”

Hagen thinks that GPs are traditionally insufficiently aware of the long-term consequences of using pain-relief medications.

“It’s great that information about the subject and simple remedial measures seems to have a good effect.”

Why some and not others?

Saxhaug Kristoffersen says the researchers are pretty much in the dark about why medication over-use leads to chronic headaches among about half of those who have these frequent pains, but not the other half of the patients.

“We know that you must have a migraine or headache as a root problem to develop medication over-use headaches. This is because the same result doesn’t seem to apply to rheumatism patients, for example, who also frequently use pain-relievers,” he points out.

Partly about education

Knut Hagen thinks that those who fall into the vicious circle of medication over-use are not just random, unfortunate patients.

“We know from research here at NTNU that one factor is education level. The more education you have, the more likely you are to understand the pitfalls of using painkillers. We know that those who risk this type of headache also suffer other maladies, particularly anxiety and depression. Lifestyle factors such as smoking and physical inactivity also contribute negatively.”

The headache specialist thinks the general public tends to know too little about the downside of extensive pain-pill popping.

“When GPs are insufficiently updated in this area it’s hardly surprising that many patients are unaware of the risks,” he says.

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Read the Norwegian version of this article at forskning.no

Translated by: Glenn Ostling

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