Q: I have suffered from almost daily headaches for the last year and take up to 8 paracetamol a day. My GP thinks it is a classic case of tension headache and he wants me to stop all painkillers as he feels they are making things worse. How could that be?
A: Tension headaches generally respond well to reassurance, identifying and tackling underlying stress, and simple over-the-counter painkillers like ibuprofen or paracetamol.
Taking painkillers on an ad hoc basis for occasional tension headaches does no harm, but if they become more regular and you start to take painkillers on a daily basis then you risk entering a vicious cycle that will continue long after the underlying cause of the headache has disappeared.
Put simply it is thought that you can “get used” to daily doses of painkillers and if you don’t take them the headaches worsen. So you take more painkillers, perpetuating the cycle.
Milder cases can be effectively treated simply by stopping the painkillers and putting up with a headache until it subsides (generally within a couple of weeks). But more established ones often require the addition of another drug (such as small nightly doses of the antidepressant amitriptyline) to aid the weaning process.
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