The headache that headache pills give you

Taking painkillers or triptans too often can make headaches more frequent. It's called medication overuse headache, it's common, and it's treatable once you know what to look for.

What it is

Medication overuse headache (MOH) happens when headache medicines are taken so often that they start causing headaches themselves. The brain gets used to regular doses and becomes more sensitive to pain. As each dose wears off, the headache comes back, often worse, so you take another.

Over weeks and months the headaches become more frequent, and it's easy to assume your migraine is simply getting worse. It is one of the most common causes of daily or near-daily headache, affecting around 1 to 2 in every 100 adults.

It happens to people trying to cope

MOH isn't a sign of carelessness. It usually affects people doing their best to manage frequent attacks: taking a triptan to get through a working day, or paracetamol so they can be there for their family. It builds so gradually that it's easy to miss, and there's always something else to blame, like stress, poor sleep or hormones.

The numbers to watch

MOH becomes likely when, for more than three months, you take:

• triptans, opioids or combination painkillers such as co-codamol on 10 or more days a month
• simple painkillers such as paracetamol, ibuprofen or aspirin on 15 or more days a month

It's the number of days that counts, not the number of tablets. Two tablets on the same day still count as one day.

How to spot it early

We're poor judges of slow change. Bad days stick in the memory and ordinary ones don't, so it's hard to notice that twice a week has become most days. That's why NICE recommends a headache diary for anyone with frequent headaches.

• Log every headache and every dose: the date, the medicine and how much you took.
• Count medication days, not just how bad the pain was.
• Start before a bad patch. Two months of records gives you and your GP a baseline to compare against.

Let the diary do the counting.The free Migrevention diary tracks your medication days and flags when you're getting close to the overuse threshold.

Get the free diary

If you think you're already in the cycle

The good news is that MOH is treatable, and most people's headaches improve once the cycle is broken.

Talk to your GP before you stop anything. NICE advises stopping the overused medicines completely for at least a month, usually all at once. Some medicines, including strong opioids, need a slower plan with specialist support.

• Expect a difficult couple of weeks. Headaches often get worse before they get better, and you may sleep badly or feel sick for a while. This is temporary.
• Ask about a preventive. A daily preventive medicine reduces how often you need painkillers, which helps keep the cycle from coming back.
• Keep your diary going. Your GP will usually check in 4 to 8 weeks after you stop, and your records show whether it's working.

MOH isn't a failure of willpower. It's a well-recognised condition with a clear cause, clear thresholds and a clear way out. The hard part is noticing it, and that's where a few weeks of honest records make all the difference.

Sources: NICE CG150, Treatment for medication overuse headache. International Classification of Headache Disorders, 3rd edition (ICHD-3).