October 2008
Are you making your headaches worse?
Orly Avitzur, M.D., a board-certified neurologist, is a medical adviser to Consumers Union.
My patient, a 38-year-old receptionist, sat down in my office and began to cry. Although she had experienced migraines several times a year since her teens, for the past few months she had been suffering from headaches daily.
Over-the-counter pain relievers were no longer effective and she was barely functioning at work. She had been taking up to three tablets of Advil (ibuprofen) or two tablets of Excedrin three times a day and often added Tylenol PM when she was unable to sleep.
Although she didn’t realize it, she had made the problem worse. Her regular use of pain relievers had brought on a condition known as medication-overuse headache, which affects up to two-thirds of patients who seek help at headache treatment centers in the U.S.
The International Headache Society defines medication-overuse headaches as those that are present for at least 15 days a month or have developed or markedly worsened because the sufferer took too much medication.
The problem, previously known as "rebound headache," can be caused by prescription pain medications, over-the-counter pain relievers, or combinations of medications. Almost all such drugs have the potential to cause medication-overuse headaches; some experts believe the most common culprits to be preparations containing barbiturates (such as Fioricet and Fiorinal), opioids, acetaminophen, nonsteroidal anti-inflammatory agents such as ibuprofen (Advil and generic) or naproxen (Aleve and generic), and migraine-specific drugs called triptans (such as Imitrex and Maxalt).
The ready availability of nonprescription pain relievers on drugstore shelves and in many homes might add to the problem. A recent Consumer Reports survey of more than 6,000 subscribers confirmed that most of their medicine cabinets did contain over-the-counter pain-relief drugs including acetaminophen (73 percent), ibuprofen (73 percent), and aspirin (69 percent). In a more comprehensive online survey of 47,283 Consumer Reports subscribers last year, 31 percent admitted that they did not always carefully follow directions on labels, and some readers acknowledged that they don’t consider nonprescription medication to be as "serious" as prescribed drugs. Those who routinely overused the drugs justified it because their pain was severe, they felt no side effects, or they believed that their above-average weight or height warranted the additional medication.
It has been estimated that about 25 percent of Americans exceed the recommended dosage when they take nonprescription pain drugs. And it’s not just headaches that beget headaches when overtreated. In a March 2008 European Journal of Neurology study of patients at a rheumatology clinic who were taking pain relievers for joint pain and arthritis, researchers found that 70 percent were overmedicating and 8 percent exhibited symptoms of medication-overuse headaches. And what about my patient? After three months of cutting out caffeine and all her pain medications, eating a more healthful diet, and exercising at a gym, she was finally headache free.
Over-the-counter pain relievers were no longer effective and she was barely functioning at work. She had been taking up to three tablets of Advil (ibuprofen) or two tablets of Excedrin three times a day and often added Tylenol PM when she was unable to sleep.
Although she didn’t realize it, she had made the problem worse. Her regular use of pain relievers had brought on a condition known as medication-overuse headache, which affects up to two-thirds of patients who seek help at headache treatment centers in the U.S.
The International Headache Society defines medication-overuse headaches as those that are present for at least 15 days a month or have developed or markedly worsened because the sufferer took too much medication.
The problem, previously known as "rebound headache," can be caused by prescription pain medications, over-the-counter pain relievers, or combinations of medications. Almost all such drugs have the potential to cause medication-overuse headaches; some experts believe the most common culprits to be preparations containing barbiturates (such as Fioricet and Fiorinal), opioids, acetaminophen, nonsteroidal anti-inflammatory agents such as ibuprofen (Advil and generic) or naproxen (Aleve and generic), and migraine-specific drugs called triptans (such as Imitrex and Maxalt).
The ready availability of nonprescription pain relievers on drugstore shelves and in many homes might add to the problem. A recent Consumer Reports survey of more than 6,000 subscribers confirmed that most of their medicine cabinets did contain over-the-counter pain-relief drugs including acetaminophen (73 percent), ibuprofen (73 percent), and aspirin (69 percent). In a more comprehensive online survey of 47,283 Consumer Reports subscribers last year, 31 percent admitted that they did not always carefully follow directions on labels, and some readers acknowledged that they don’t consider nonprescription medication to be as "serious" as prescribed drugs. Those who routinely overused the drugs justified it because their pain was severe, they felt no side effects, or they believed that their above-average weight or height warranted the additional medication.
It has been estimated that about 25 percent of Americans exceed the recommended dosage when they take nonprescription pain drugs. And it’s not just headaches that beget headaches when overtreated. In a March 2008 European Journal of Neurology study of patients at a rheumatology clinic who were taking pain relievers for joint pain and arthritis, researchers found that 70 percent were overmedicating and 8 percent exhibited symptoms of medication-overuse headaches. And what about my patient? After three months of cutting out caffeine and all her pain medications, eating a more healthful diet, and exercising at a gym, she was finally headache free.
