When pills offer no relief

Headache sufferers may be overusing painkillers, making them less effective, says study.

That pill you pop for your headache could be making it worse, says a new study of 584 patients which suggests that people may be overusing pain medication, to their detriment.

Four in 10 people surveyed said they were not satisfied with their treatment, the main reasons being insufficient pain relief and failure to reduce attacks.

And the pain was so bad for one in 10 people that they had to miss school or work for at least a week.

The frequent usage of painkilling drugs is a red flag to doctors, who believe that they are being overused.

The occasional painkiller for the occasional headache is not going to hurt. But according to a survey of patients in general practice cli­nics, about one in five people used pain medication more than four days a week – a rate that doctors deem excessive. Nearly half of those surveyed had frequent headaches – four or more a month.

Dr Charles Siow, president of the Headache Society of Singapore (HSS), said any painkilling drugs can cause headaches – like tension headaches and migraine – to recur as the brain gets accustomed to having the drug if it is taken frequently.

“Over time, when the brain gets used to a certain level of painkillers and when they drop off because they are excreted from the body, the brain will give you a headache to get you to take a painkiller,” said Dr Siow.

This brain-induced headache, also known as medication-overuse headache, would make painkillers decreasingly effective and the pain itself difficult to treat over time.

Headaches can cause several areas of the head to hurt, including a network of nerves which extends over the scalp and certain nerves in the face, mouth and throat.

Migraine headaches are more vulnerable to this kind of drug overuse, as they are recurrent and tend to be more severe and debilita­ting.

With missed work and school, impaired performance and medication costs, the overall cost of migraine suffering to Singapore is estimated at S$146mil (RM335.8mil) a year, said doctors who headed the study.

It was commissioned last year by the HSS and supported by pharmaceutical firm Janssen-Cilag. The results of the survey were published in the Singapore Medical Journal in October.

Dr Siow suggested that different strategies be employed to deal with recurrent headaches.

There is preventive medication that migraine patients can take for six to nine months until the headaches disappear.

Patients should also learn to recognise and avoid triggers, such as fatigue, stress, hormonal changes and foods such as caffeine, chocolate and red wine.

Mental state is also important in dealing with the pain.

Dr Kevin Tan, associate consultant of neurology at the National Neuroscience Institute, said: “Psychosocial issues, like when a person is depressed or anxious, can make the sensation of pain appear to be worse than it actually is.”

The survey also found that more females and non-Chinese suffered from headaches compared to males and Chinese patients. Doctors say it is not understood why but there is a hormonal component along with genetic factors that predispose some to a life of migraines.

The World Health Organisation rates migraines as one of the top 20 causes of ­disabilities in the world. In Singapore, Dr Siow estimates that 360,000 people – or one in 13 people – suffer from migraines.

First-year polytechnic student Foo Sok Leng, 22, used to have migraine attacks three times a week in 2005, which then worsened to one every day. She took paracetamol for the pain three times a week but it remained constant.

“It was a very difficult time for me as I had to miss school and was in and out of hospital for more than a month,” she said.

As a result, Foo had to retake her A-level examinations the following year. Now she has started preventive medication, which has reduced her headaches substantially, she said.

Dr Siow said the survey showed that physicians need to pay attention to their patients’ complaints of headache, to prevent drug overuse.

The survey also found that patients tend to doctor hop as they go in desperate search of pain relief.

“Headache is so common that it slips under the radar. But people forget that having a headache is not normal,” said Dr Siow.

– The Straits Times, Singapore/Asia News Network