Headache and facial pain

Medication-overuse headache

When medication intended to relieve attacks quietly becomes part of increasingly frequent headache.

This is not a lack of willpower. People take medication because they are in pain. Good care addresses both the overuse and the underlying headache disorder.

The painkiller trap

What is medication-overuse headache?

In someone with a pre-existing headache disorder, using acute medication too frequently can contribute to increasingly frequent headache. The original features of migraine or tension-type headache may become less distinct.

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Headache usually came first

Migraine or tension-type headache usually underlies the pattern. Taking pain medication for another condition does not automatically cause this same headache disorder.

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Count medication days

The key measure is not the number of tablets taken on one day, but the number of days per month on which medication is used.

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The pattern becomes blurred

Headache may become almost daily, medication may work for less time or less well, and the original attacks may become harder to recognise.

For more than 3 months

Which classification thresholds are used?

The diagnosis requires headache on at least 15 days per month, with regular overuse of one or more acute headache medicines for more than 3 months.

Simple painkillers

15+

days per month with paracetamol, aspirin or NSAIDs such as ibuprofen, naproxen or diclofenac.

Other acute medication

10+

days per month with triptans, opioids, ergots or combination analgesics.

A threshold is not a personal prescription

Medication can still be unsafe or unsuitable below these thresholds, for example with stomach, kidney, heart or vascular problems, pregnancy or interactions. Discuss your medication with a doctor or pharmacist.

Signs of the cycle

What can the pattern look like?

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On waking

Headache may already be present in the morning or sometimes wake you during the night.

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Increasingly often

The number of headache days and medication days gradually rises.

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Shorter effect

Medication helps less well or the headache returns quickly.

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Wider burden

Fatigue, nausea, irritability, difficulty concentrating, restlessness or low mood may also occur.

“I take something because I have a headache; then I get a headache when I take nothing.”
Example of the pattern, not a literal patient quotation.

Make it visible

Count every day on which you use medication

A day with one tablet counts as one medication day. A day with several doses also counts as one day. Record each medicine separately and count days on which medicines are combined.

An example month

Illustration: coloured squares are medication days. Record the actual medicine and dose separately.

Take to your appointment

all medicines, including over-the-counter products;
the number of use days for each medicine;
why you used it;
headache days and the original attack patterns;
what you tried before and what contributed to relapse.

Treatment with support

Withdrawal is more than “just take nothing”

Guidelines generally recommend stopping the overused acute headache medication. Headache may temporarily worsen and withdrawal symptoms can occur, so discuss the approach and support you need in advance.

Discuss the plan first.
Review what you use, whether abrupt withdrawal is safe and what support you need.

Prepare for the difficult first days.
Withdrawal headache, nausea, sleep problems and limitations in work or daily activities may occur.

Arrange follow-up.
Contact helps address relapse, mood, functioning and medical questions in time.

Recognise the underlying headache afterwards.
After withdrawal it may become clearer whether migraine, tension-type headache or both need treatment.

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Do you use opioids?

Do not stop tramadol, oxycodone, fentanyl, morphine or other opioids on your own. A personalised tapering and safety plan or specialist support may be needed.

Preventing relapse

Treat what lies underneath

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Targeted acute treatment

Agree which medicine fits which attack pattern, when to take it and the maximum number of use days.

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Consider prevention

Preventive treatment may be appropriate for frequent migraine or chronic tension-type headache. Choice and evaluation are individual.

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A relapse plan

Record whom to contact if medication days rise again, attacks change or treatment is not working well enough.

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The care trap is not only in the medicine

If the original headache is not properly treated, the need for rapid relief remains. A good plan therefore covers diagnosis, prevention, work, sleep and control—not only counting pills.

Share your experience

What helped you out of the painkiller trap?

We are looking for experiences with explanation, withdrawal, support, relapse and treatment of the underlying headache.