Medicine Overuse Can Increase Headaches
People who regularly take headache medication more than twice weekly might be making their conditions worse, putting themselves at risk for “medication overuse headaches” – a common, but under-recognized medical problem.
People with this condition are stuck in a vicious cycle. Their headaches become more frequent as they take more headache medication. The more painkillers they use, however, the more headaches they get, thus the need to take even more medication.
“It is an easy cycle for people to fall into,” said Mona Chitre, Pharm.D, Vice President, Pharmacy Management at Excellus BlueCross BlueShield. “We want people to be aware of the dangers of taking too much headache medication, which includes popular, readily available drugs like ibuprofen and acetaminophen that, if taken too often, can increase the severity and frequency of headaches.”
There are several warning signs that a person is overusing headache medication. Is their medication less effective, for example, even with increased dosages? Have they been taking the medication at least three times a week for a few months?
Researchers estimate that one in 100 people suffer from medication overuse headaches. Chronic headaches can be debilitating for the patient, affecting their personal and professional lives.
Excellus BlueCross BlueShield believes education will help people with this problem, and conducted a pilot program that did just that.
“We looked at one group in danger of having this problem: People who appeared to be taking too much prescription headache medicine,” Chitre said. “Through member mailings and physician education, we saw about half of the targeted members reduce their intake of the offending drug by about 40 percent. Many patients started on preventive treatment to break the daily headache cycle.”
Excellus BlueCross BlueShield mailed educational brochures and headache calendars to about 1,000 members, and sent materials and alerts to doctors with at-risk patients. Results from Excellus BlueCross BlueShield’s program have been presented at national conferences and also published in the May 2006 issue of "Headache: The Journal of Head and Face Pain.”
A patient battling a chronic headache should consult with his or her primary care physician since a doctor is best able to diagnose the problem. A patient diagnosed with a medication overuse headache could be weaned off the headache drug, given beta blockers or other preventive treatments, and asked to try to identify and avoid headache triggers.
Here are other tips for dealing with a persistent headache:
- Keep a headache diary: Tracking medication use and the frequency and severity of headaches will help the patient and his or her doctor to identify headache triggers. Template diaries can be downloaded from http://www.headaches.org.
- Regulate sleep: Establish a regular time to go to sleep and wake up.
- Monitor diet: Avoid triggers such as caffeine or skipping meals.
- Relaxation techniques: Exercise, yoga and meditation can help.
Common headache medications that if taken too often could cause medication overuse headaches include:
- Aspirin or acetylsalicylic acid (Bufferin, Bayer, Ecotrin, St. Joseph’s)
- Acetaminophen (Tylenol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen (Advil, Motrin, Nuprin), and naproxen sodium (Naprosyn, Aleve)
- Combination products: aspirin, acetaminophen and caffeine (Excedrin for Migraine, Extra Strength Excedrin, Vanquish); aspirin and caffeine (Anacin); or acetaminophen and caffeine (Aspirin Free Excedrin)
- Triptans: almotriptan (Axert®), eletriptan (Relpax®), frovatriptan (Frova®), naratriptan (Amerge®), sumatriptan (Imitrex®), rizatriptan (Maxalt®), zolmitriptan (Zomig®)
- Opioids: hydrocodone/APAP (Vicodin®)
- Butalbital-containing drugs: Fiorinal and Fioricet
- Ergot compounds (e.g., Cafergot)
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