Drug-induced headache belongs to the group of secondary headaches, which are usually caused by painkillers or other medications. This type of headache can be unilateral or bilateral. Drug-induced headache is generally easily treated.
What is medication-induced headache?
Infographic on the causes and symptoms of migraine and headache. Click image to enlarge. A medication-induced headache is present when persistent headaches occur on at least 15 days per month. These headaches occur after taking pain-relieving medication for more than 10 days per month for more than three months. Drug-induced headache is not a primary, or stand-alone, headache such as migraine or tension headache. However, primary headache is a prerequisite for drug-induced headache to develop. There are three types of medication-induced headache: chronic migraine, chronic tension headache and chronic combination headache. In addition to analgesics, other drugs can also cause medication-induced headache. It is important to consider whether the medication was used primarily to treat headache or for another condition, because drug-induced headache can also occur as a side effect of long-term medication.
Causes
The cause of medication-induced headache is a headache that has been excessively treated with pain medications. Usually, migraine and tension headaches are the primary headaches. Not every form of headache automatically leads to medication-induced headache. Cluster headache usually leads to medication-induced headache only in exceptional cases, even with excessive use of analgesics. It should also be noted that analgesics taken for rheumatic diseases, injuries, and other conditions are not considered a cause of drug-induced headache. Because a specific cause of medication-induced headache has not been identified to date, it is thought that a genetic predisposition may be a possibility.
Typical symptoms and signs
- Pressing-dull to stabbing (also throbbing) headache.
- Sensitivity to light
- Flickering before the eyes
- Sensitivity to noise
Diagnosis and course
Diagnosed the drug-induced headache by the general practitioner as well as by the neurologist. After a detailed anamnesis, the affected person is usually recommended to keep a so-called headache diary over a longer period. Furthermore, a general physical examination and a blood analysis are performed. The neurologist examines the patient’s neurological status with the aid of EEG and other neurological examination methods. If the blood analysis reveals abnormalities, an internist can also be consulted. Especially after years of painkiller abuse, the kidneys and liver may have been damaged. The condition of the internal organs is determined with the aid of further blood analyses. Furthermore, imaging techniques such as ultrasound are used to determine whether there is damage to the organs and if so, to what extent. The course of drug-induced headache can be described as good. With adequate therapy, the success rate is 80 percent. Depending on how long the medication-induced headache has been present or how long the pain and medication abuse has been practiced, complications may arise in the further course. In addition to liver and kidney, gastric ulcers and gastric tumors can occur. Sufferers with medication-induced headache also often present with depression, but this can be well treated with behavioral therapy.
Complications
In this complaint, the patient experiences a very severe headache. In most cases, this pain is usually stabbing or pressing and thus can significantly reduce the quality of life. The affected person’s concentration and coordination are also reduced by this complaint. The pain not infrequently spreads from the head to other regions of the body and can also cause discomfort there.Sometimes sensitivity to light also occurs, so that the headache is further aggravated by bright light. Sensitivity to noise may also occur. Patients often have a flickering sensation before the eyes and can no longer perform their usual activities. The symptoms themselves can be easily limited by discontinuing the respective medications or replacing them with others. In particular, those affected must refrain from taking painkillers. This can also lead to withdrawal symptoms. If this complaint is not treated, it can also lead to inflammation of the stomach or, in the worst case, to kidney failure, which is fatal without treatment. Usually, life expectancy is also reduced by the disease if there is no treatment of this complaint.
When should you go to the doctor?
If a headache occurs repeatedly after taking a medicine, the first step is to read the listed side effects in the package insert. If several medicines are taken at the same time, the information about possible interactions of the preparations should also be read. If the headaches occur repeatedly or increase in intensity, the attending physician should be consulted about the side effects. It is not recommended to interrupt the treatment plan on one’s own responsibility, as the underlying disease must be treated. Together with the physician, possible alternatives to the administration of medication should be discussed so that there is no further deterioration of the general condition. In case of existing light sensitivity, flickering perception in front of the eye or blurred field of vision, the observations should be discussed with the physician. If there is sensitivity to noise, a further decrease in well-being or sleep disturbances, a visit to the doctor is necessary. If there is an inner restlessness, a decrease in physical as well as mental performance and a disturbance of attention, a doctor is needed. If medication is taken over a long period of time, the headache may develop slowly and continuously increase in intensity. This is a gradual process of drug-induced headache. A physician should be consulted about the discomfort so that optimization of the treatment plan developed can occur.
Treatment and therapy
Successful treatment of a medication-induced headache involves stopping the triggering pain relievers and medications at the very beginning. Because over the course of months and years the condition is often addiction-related, detoxification or withdrawal is the treatment of choice. The prerequisite for this, however, is that the patient wants this 100 percent, because by giving up painkillers, a so-called rebound effect sets in, which means that the pain intensifies when the medication is discontinued. These withdrawal headaches can usually last up to three weeks. Since, in addition to the medication-induced headache, depression is often also present in those affected, it is advisable to undergo inpatient withdrawal. In addition to treating the pain and other withdrawal symptoms with specific medications, behavioral therapy is an important factor in ensuring the success of treatment. Once the symptoms have subsided, it is important to find and treat the cause of the causative headache. Therapy begins during withdrawal and continues over the long term in subsequent months. In addition to adequate pain management and psychological behavioral training, it is important that physiotherapeutic measures are also taken, especially when tension headaches are the cause of the medication-induced headache. The treatment of medication-induced headache also provides for the treatment of the consequences of painkiller abuse. Excessive use of painkillers mainly damages stomach, liver, kidneys as well as blood vessels. Gastritis, peptic ulcers, hepatitis, and renal insufficiency are just some of the diseases that can occur as a result of drug-induced headache.
Outlook and prognosis
The prognosis for medication-induced headache is favorable. After discontinuation of the medication used, there is a gradual regression of symptoms. Normally, freedom from symptoms is achieved within one day.Therefore, spontaneous healing can be expected if the affected person stops using the painkillers taken in the future. Supportively, the affected person can increase the intake of fluids. This helps to ensure that the ingested drugs are removed from the organism and excreted. If the active ingredients that triggered the health problems in the organism are reintroduced to the body, the symptoms are likely to return. The affected person should therefore permanently resort to alternative preparations. It is advisable to discuss the side effects that have occurred with the attending physician. The treatment plan for the primary disease is revised and adjusted accordingly. If there is no underlying disease, it is sufficient to refrain from using the painkillers supplied. Nevertheless, it is advisable to seek medical treatment to clarify the cause of the pain. In order to ensure a lasting freedom from symptoms of the medication-induced headache, the active substances contained in prescribed or purchased medications should be monitored over the course of the patient’s life. Long-term abstinence from the triggering elements is necessary.
Prevention
Drug-induced headache can be well prevented. The most important point is to take painkillers and migraine medications for headaches on no more than a maximum of three consecutive days and on no more than a maximum of ten days per month. If a primary headache is present, painkillers should be taken only in the allowed dosage and duration according to the package insert. If the headache does not subside within 48 hours, consult a physician who may prescribe other, more effective medications. Since a medication-induced headache is a consequence of other headaches, it is advisable to keep a so-called headache diary. In this way, one can facilitate the diagnosis and cause finding. In addition, the diary serves as a monitoring tool so that accidental or intentional overuse of pain medication can be avoided. Since primary headache is often triggered by tense muscles (tension headache), it is useful to take physiotherapeutic measures so that the primary does not develop into a medication-induced headache.
What you can do yourself
Patients with a medication-induced headache can try to switch to alternative ways of managing pain. Relaxation techniques have been found to be particularly helpful. After learning certain exercises, these can be performed independently and entirely at the patient’s own discretion at any time. Various techniques are used to build up the mental strength of the person affected, and stress can be reduced. Methods such as meditation, autogenic training or yoga have proven to be beneficial. Many patients have succeeded in reducing the dose of painkillers or switching to a drug that is less rich in active ingredients. In addition, there are various natural remedies that have proven effective in combating pain. These include devil’s claw, ginger, willow bark, arnica or curcumin. If the pain can be relieved via these, the pain medication can also be changed and altered. In case of a headache, the patient should sleep sufficiently and under good conditions, if possible. Sleep hygiene should therefore be optimized and the daily routine should be adjusted to meet the needs. Another possibility to reduce or stop the painkillers is the method of acupuncture. Depending on the cause of the pain, the patient can achieve relief from the symptoms through the natural healing method. This can lead to freedom from pain so that medication is no longer needed.