Many people who suffer from typical tension-type headache, or the more complex migraine, would reach for the simple pain reliever to reduce their headache. And initially, a couple of tablets would quell the headache. But over time, these medications need to be taken more frequently and at a greater dose to try and achieve the same result.
Headache Australia is a division of the Brain Foundation, and was established in 1970 by members of the Australian Association of Neurologists and Neurological Society of Australasia. They have in the past used terms such as rebound headache, withdrawal headache, analgesic rebound headache or drug-induced headache but have more recently began using the term medication-overuse headache (MOH).
MOH is a type of chronic headache that can develop from using acute headache medication too often. MOH is a very common problem in those suffering from migraine and tension-type headache who have been trying to manage their headaches with acute medications rather than preventative medications. Around one per cent of the population is suffering from MOH and these headaches can arise from taking as few as ten doses of painkillers for headaches in a month and the commonly used paracetamol (panadol), NSAIDs (nurofen, voltaren), codeine and triptans are the most likely involved.
The diagnosis of MOH is made if the headaches occur on more than 15 days per month for at least three consecutive months, in conjunction with the regular use of painkillers. It is now the third-most common headache after tension-type and migraine headaches. So while over-the-counter analgesic medications may be a fast, short acting remedy for headaches, the longer term use may alter the pain processing mechanisms in the brain. This creates a situation where the patient becomes over-sensitised and this may result in more frequent headaches. The cycle is perpetuated and often more medication is sought. Stopping the medication may even end in withdrawal symptoms and significantly more pain.
Initially, the most important thing for the headache sufferer is a clear diagnosis:
- Is the headache of the primary type, such as migraine headache, tension-type headache (TTH), cluster headache or cervicogenic headache (referred from neck structures).
- Or is the headache of the secondary type, and potentially related to jaw problems, sinus issues, meningitis, stroke, underlying brain tumour, whiplash / trauma or dental problems.
Most commonly, tension-type headache and migraine top the list. Many people suffer both from tension-type and migraine and will often describe their “normal everyday” type headache and then their less frequent “migraine attack”. Professor James Lance has spoken of migraine as possibly on a “Headache Spectrum” with tension-type at one end and migraine at the other. This concept can be useful in diagnosing those patients whose headaches wax and wane between the two types.
People who are suffering from frequent headaches and are using pain medications regularly should have a discussion with their GP or neurologist to help them determine if they may be suffering from MOH.