Headaches are one of the most common health problems in the UK: more than 10 million of us experience them on a regular basis. They cause four percent of our visits to GPs, and are responsible for about 25million days a year taken off sick from work or school. Those statistics add up to a lot of pain.
Now the National Institute for Health and Clinical Excellence (NICE) has brought out new guidance for GPs and other health professionals. The guidelines could make a difference to how doctors – and their patients – tackle the pain of headache.
Painkillers for headaches
We can drop into a pharmacy or a supermarket and buy a packet of painkillers – paracetamol, aspirin and ibuprofen on any day of the week. Or, if the problem is more severe, may have a prescription from our doctor for stronger painkillers, such as triptans and opioids. However, taking too many of these over a short period of time can actually makes our headaches worse, not better.
The NICE guidelines to healthcare professionals say they should watch out for “medication overuse” as a possible cause of patients’ headaches. “Taking these medicines for more than 10 or 15 days a month can cause medication overuse headache, which is a disabling and preventable disorder,” says Dr Martin Underwood, a GP and professor of primary care research at Warwick Medical School, who chaired the guidelines’ development.
Treatment for migraines
“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,” he says.
“The important thing here is to bear in mind the limits that we have identified,” says Dr Manjit Matharu, an honorary consultant neurologist at the National Hospital for Neurology and Neurosurgery, who worked on the development of the guidelines.
Triptans and opioids
“If you take the common painkillers, paracetamol, aspirin, or the anti-inflammatory drugs such as ibuprofen, and you take them up to about 15 days per month, you’re probably going to be fine. For the stronger painkillers, the drugs called the triptans and the opioids, you can only take them up to 10 days per month before you start running into trouble.
“If someone is already over those limits, there’s something to be said for just stopping them. Essentially you’re getting the painkillers out of your system and then you can see where you are. With the majority of people, their headaches improve dramatically, and you find that you’ve got a relatively low frequency of headaches.
“You can go back to taking the painkillers, and provided you stick to those limits [see above], you should be fine. What I say to my own patients is, if you are already having a relatively high frequency of headaches, and are having to take painkillers on a fairly frequent basis, it might make more sense to take preventative treatments, before you start having to take more painkillers.
Taking migraine medications
“For migraine, we identified drugs called topiramate, and propranolol as useful. You can start taking these drugs and we hope that you’ll reduce the frequency of headaches you’re having, so you won’t have to worry about taking too many painkillers. You can still safely take them, provided you stick to the limits I mentioned.”
If you’re taking the low-dose 75mg aspirin on a daily basis for heart problems, it doesn’t seem to cause problems, so don’t stop taking it.
There’s also an alternative approach to pain control while you’re not taking your usual painkillers. If you have tension-type headaches or migraine, NICE has suggested a course of up to 10 sessions of acupuncture over five to eight weeks to relieve the pain of tension-type headache and migraine.
Acupuncture and pain
Studies have shown that acupuncture works for these kinds of headache. “What we were looking for in the studies was controlled data,” explains Dr Manjit Matharu. “We identified studies that included sham and real acupuncture, and saw there was a clear difference. The real acupuncture was better than sham acupuncture.
“I came to this as a sceptic, but the evidence is what it is. If we have something that works, I think we should offer it to patients. This is a deal I would take.
“If we tell doctors about this they can help to deal with the problem when it has happened. If we can get this message to people who aren’t health professionals, then we can help stop this problem occurring,” says Dr Matharu.
The acupuncture community in the UK is, not surprisingly, pleased with this news. “Our aim is to use acupuncture to restore balance to the body,” says Rhiannon Griffiths, acupuncture practitioner and member of the British Acupuncture Council. “We look at the whole person, and what’s going on in their lives. Acupuncture also treats the painful symptoms. We have patients who come in with a headache, and leave without it.
“Once we’ve treated the root cause with the initial treatments, we can space the remaining treatments out. You may only need to come in once a month, or every couple of months.”
The disadvantage with acupuncture is that it is considerably more expensive than a pack of 16 paracetamol or ibuprofen from your chemist. An hour-long session costs around £40 -£45 (more in London), and the initial, longer session can cost around £55 - £65 (or more, depending on where you live). But for those who can afford the treatment, there’s the possibility of relief from pain – and painkillers.
Your guide to headache types
Headaches are usually divided into two main groups, primary and secondary.
PRIMARY headaches are those that aren’t associated with another health problem.
Tension headaches are the most common. They can be caused in different ways, for instance, through being dehydrated, not getting enough sleep, stress and depression.
There are some fairly obvious ways of dealing with these headaches, depending on the cause. Making sure you have enough to drink, getting more sleep, and doing something to help reduce your stress levels, such as taking gentle exercise, for instance, walking outdoors, can all help. Meditation, yoga and tai chi can also help relax your mind and body.
Migraines can vary a great deal from one person to another. Some people will go for years between one migraine and the next, while others may have them every week or more. The headaches that come with migraines can be very painful, and you may be very sensitive to light and sound, feel sick, and have problems with your vision. In some cases over-the-counter medicines are enough to ease the symptoms, but your GP can prescribe medication if you need it.
Cluster headaches are relatively rare, but if you do have them they can be extremely painful. The pain is usually centred around one eye, or localised on one side of your head. They are known as cluster headaches because sufferers have bouts when they have a number of these headaches over a few weeks or months, and then may have none at all. Prescription medications can help to ease the pain.
SECONDARY headaches are the result of another health problem, such as a cold, a head injury, concussion, the menopause or an allergic reaction.
They can also be the result of overusing medication [see above].
Sometimes the cause of the headache is obvious – for instance if you have a streaming cold or blocked up nose, or had too many glasses of wine the night before. There are occasions though, when it’s hard to find a reason why you have very painful headaches.
When you’re feeling awful it can make you fear the worst – that your headache is the result of something sinister, such as a brain tumour. This is extremely unlikely, as they really don’t happen often. If you’re worried though, it’s worth talking to your GP about your concerns.