How to Be Healthy: Headaches
Pat Thomas looks at this common complaint – and how the most common treatment for it may just pile on the pain.
In the mid 1970s, US Federal analgesics that they are widely, but wrongly, used to treat other types of no different from ‘pushers’. ‘We’ve got ‘pain’ for which they are not a drug problem in America,’ he stated. ‘It’s called television.’ Of course, the idea was considered absurd – mostly by drug companies. But the point, which was well made then, is still relevant.
Encouraged by advertising that often depicts pain as an enemy that stops us from living life at full tilt, we down handfuls of analgesics (painkillers) each year. Eighty-five per cent of painkillers are sold over the counter and form the largest part of the OTC drugs market. Up to 70 per cent of the population in the West uses analgesics regularly, primarily for headaches, but also for other pains and to reduce fever.
Women consume more painkillers than men by a huge margin., But so confident are people generally in the pain-deadening properties of analgesics that they are widely, but wrongly, used to treat other types of ‘pain’ for which they are not recommended – such as bad moods, anxiety, sleep problems and stress.
Around 20 per cent of adults suffer from chronic headaches; migraines comprise eight per cent of all headaches. Headaches are responsible for more presentations to general practitioners, and more drugs are prescribed, or bought over the counter, for headaches then for any other condition.
Because chronic headaches tend to strike people during their ‘productive’ years (ages 20 to 50) they are also among the most common reasons for days off work.
In truth, we do not really understand the mechanism of headache well. A headache can be muscular, spinal or circulatory in origin. It can also be caused by different external triggers including chemical sensitivity, changes in weather or in sleeping patterns, stress and particular foods, for instance artificial sweeteners like aspartame and sucralose, or foods containing amines (such as pickles, caffeinated drinks, flavour enhancers such as MSG, chocolate and processed meats).
Coffee consumption and daily smoking also make regular headaches more likely. Women on diets (around 50 per cent) take greater amounts of OTC analgesics, to combat the headaches that result from lack of proper nutrition.
Women are also three times more likely to suffer from severe headache (eg. migraine) than men, as are those who have a family history of migraine. Taking the birth control pill can raise a woman’s risk of chronic headaches. There is some evidence to suggest a link between a woman’s normal monthly hormonal fluctuations and headache, while in men hormone levels do not appear to play a role. In short, the causes of headaches may be as individual as the people who suffer from them.
On the rebound
Headache is now so common that, without careful diagnosis, it is hard to separate primary headaches – eg. those caused by the conditions listed above – and secondary headache, caused by over-consumption of headache medication. This phenomenon is known by the medical profession as medication overuse headache, or MOH. Around 20 per cent of people with chronic headaches and most with daily headaches suffer from analgesic rebound headaches, and this is five times more common in women than men.
Overuse of painkillers often has an addictive, psychological component. Without addressing this, it can be hard to convince sufferers to stop taking the pills. But other factors can turn analgesics into problems. For instance, many headache medications are combinations of ingredients. A common additive is caffeine – usually around 30–60mg per tablet. Caffeine enhances the painkilling actions of many analgesics, but can cause a rebound headache.
Rebound headache is just one of the trade-offs for ‘fast relief’. A large 1994 study comparing the treatment of tension headaches with paracetamol, or paracetamol plus caffeine, or aspirin, found significantly more side effects (eg stomach discomfort, nervousness and dizziness) with the paracetamol preparations containing caffeine. The authors noted that this resulted from an unintended interaction of the ingredients, since neither paracetamol nor caffeine would be expected to produce such side effects by themselves at the doses used.
Sometimes the adverse effects are more serious. Studies show that one to seven days of treatment with aspirin or ibuprofen produces lesions (scars) in the gut lining in 20 to 50 per cent of otherwise healthy individuals.
While paracetamol does not cause gastrointestinal problems, it can cause liver damage, even at therapeutic doses, because metabolising paracetamol requires the enzyme glutathione, produced in the liver. Large regular doses of paracetamol deplete the liver of glutathione, leaving it vulnerable to cellular damage. Because of this damage, a paracetamol overdose can be fatal. This can be prevented if an antidote is given within 16 hours of taking the drug, but there’s a catch.
The first symptoms of overdose – gastrointestinal pain, vomiting and loss of appetite – may not appear for 24 hours, and abnormal liver function may not be apparent for 48 hours.
Other evidence indicates that almost any analgesic, if overused, can cause kidney damage. The absolute risk of end-stage renal disease for an ‘abuser’ of OTC analgesics is in the same range as the risk of lung cancer for a smoker: 1.6 in 1,000 people per year for those who abuse analgesics versus 2.1 in 1,000 for those who smoke.
Overuse is drug abuse
Abuse of OTC analgesics is widespread. Many users are in denial about the amount they take. For example, studies looking for the presence of painkillers in the urine of people whose guts have been damaged by aspirin show that around 10 to 13 per cent of regular users denied using aspirin at all.
While tackling individual causes can be effective, the medical treatment of headaches is often hit and miss. Medical literature is full of survey data showing that people with difficult-to-treat pain are perceived in a negative light by healthcare professionals who find their symptoms hard to understand or treat. But while encouragement to use OTC painkillers may get these patients out of the waiting rooms, it doesn’t contribute to good health in a positive way. It can also lead to unsupervised overuse of these medications and cause more problems than it solves.
Sidebar: Self-help for headaches
Headache is a complex health condition, with many different types. Labelling the types and causes isn’t an exact science but (very) broadly speaking, chronic headaches are an expression of ‘stress’: physical, environmental, metabolic/digestive, emotional/ psychological. The causes can become more obvious if you keep a ‘diary’ of the what, when and where of your headaches.
In addition to those in the main article, consider these common causes of chronic headache:
- Start with your back. Poor posture and/or any trauma to the spine or elsewhere can turn into headache pain. Chiropractic or osteopathy will be more effective than a pain reliever.
- Toxic air. Is daily exposure to old carpets, dust, cigarette smoke, mould, cleaning products or other chemicals causing a sensitivity or allergic headache?
- Is it eyestrain? Does the lighting in your office or home need improving? Is it time to have your eyes checked?
- Muscle tension can cause or result from headache pain. If you don’t unwind regularly, start now. Exercise, yoga, hobbies, socialising – anything that wholly absorbs you and makes you lose track of time will also relax you and reduce the likelihood of headache.
This article first appeared in the Ecologist April 2007 edition.
