Taking migraine painkillers too often can mean more headaches

The NHS advises people with migraine to try not to take painkillers for more than two days a week, because taking them too often can cause more headaches and make migraine harder to treat.

The NHS says migraine affects 10 million people in the UK.

How NICE counts it

The National Institute for Health and Care Excellence (NICE) gives doctors a different measure, counted by the month. Its guideline on headaches in over 12s tells health professionals to be alert to medication overuse headache in people whose headache developed or worsened while they were taking certain drugs for three months or more:

• triptans, opioids, ergots or combination painkillers on 10 days a month or more
• paracetamol, aspirin or an NSAID (non-steroidal anti-inflammatory drug), alone or in any combination, on 15 days a month or more

For people with medication overuse headache, NICE tells doctors to explain that it is treated by withdrawing the overused medicine, and to advise stopping all overused medicines taken for headache attacks for at least one month, abruptly rather than gradually. Symptoms are likely to get worse in the short term before they improve, and withdrawal symptoms may follow, it says. For opioids, it points to separate guidance.

If a headache diary is used, NICE says people should record for at least eight weeks how often, how long and how severe headaches are, and all prescribed and over-the-counter medicines taken to relieve them.

The NHS’s general headache page lists taking too many painkillers among the common causes of headaches.

When the NHS says to get help

The NHS says to see a GP if:

• your migraine attacks are severe or getting worse, or lasting longer than usual
• you have migraine attacks more than once a week
• you’re finding it difficult to control your migraine
• you regularly get migraine before or during your period

It says to ask for an urgent GP appointment or get help from NHS 111 if a migraine attack:

• has lasted longer than 72 hours
• comes with aura symptoms lasting longer than 1 hour at a time
• happens when you’re pregnant or just had a baby

And to call 999 if you or your child:

• have a headache that came on suddenly and is extremely painful
• have problems speaking or remembering things
• lose your vision, or have blurred or double vision
• feel drowsy or confused
• have a seizure or fit
• have a very high temperature and symptoms of meningitis
• cannot move or have weakness in the arms or legs on 1 side of your body, or 1 side of your face
• have recently had a head injury

The NHS says not to drive yourself to A&E.