Excessive use of pain relievers could worsen headaches

Got a headache? If so, Consumer Reports dares to ask whether you’re accidentally causing yourself more pain by over-treating your symptoms with common pain relievers.

It also recommends patients and their doctors consider the generic prescription-drug sumatriptan for those suffering from moderate to severe migraines, because studies show it’s cheaper than the alternatives in its drug class and often just as effective.

If you get frequent headaches, the last thing you might want to hear is that the over-the-counter or prescription medicine you use to treat them could be making your pain worse.

But that’s a distinct possibility if you take a higher-than-recommended dose or use the drug for a longer period than what the label advises, according to a new Consumer Reports review of migraine medications.

Medication-overuse headaches are typically agreed to be those that occur at least 15 times a month or worsen because of too much treatment.

Too much of a good thing

Headache-prone people can end up with “rebound” headaches for a variety of reasons, says Dr. Orly Avitzur, medical adviser for Consumer Reports and a neurologist in Tarrytown, N.Y.

Some patients mistakenly believe they can prevent headaches by continuing to take pain relievers even if their head isn’t currently throbbing, she says.

“It’s easier to just pop a pill sometimes than maybe go to a doctor and explore what’s causing the headaches or what more can be done,” Avitzur says.

Patients often seek help when their headaches persist despite self-treatment with over-the-counter medications such as acetaminophen (brand name Tylenol), ibuprofen (brand names Advil or Motrin), naproxen (Aleve), aspirin or aspirin with caffeine (Excedrin), she says.

“By the time they come in to see me, they’ve converted sporadic migraines into chronic daily headaches,” Avitzur says.

What’s more, common pain medications including ibuprofen, aspirin and naproxen can produce side effects such as nausea and gastrointestinal bleeding, which can lead to serious health problems if taken for too long.

There are many kinds of headaches – including ordinary tension-type, cluster and migraine headaches – and it can be easy to slide into damaging self-treatment habits in a desperate effort to stay functional.

While many have no serious underlying cause, some headaches can signal bigger medical problems that merit prompt professional attention, Avitzur says.

Your first or strongest headache – one that’s accompanied by speech or language difficulty, weakness, numbness or tingling – should send you to a doctor or hospital emergency room without delay, if you think it’s stroke-related.

But the good news for patients with medication-overuse headaches, she says, is that physicians can help them taper off the meds that are causing the continued or worsening symptoms and start them on preventive therapy.

Targeting migraine misery

Migraines are a kind of headache marked by a variety of neurological symptoms that can include intense throbbing on one or both sides of the head, dizziness, nausea, vomiting and extreme sensitivity to light, sound and smell.

Migraines affect more than 30 million Americans, according to the Migraine Research Foundation. Attacks affect three times as many women (18 percent) as men (6 percent).

For people with moderate to severe migraine pain, Consumer Reports recommends trying sumatriptan, available by prescription in tablet, nasal spray and injectable form. It’s been available in the U.S. since 1993 under the brand name Imitrex and went generic in 2008.

Sumatriptan is the only generic in a class of drugs called triptans. Their safety profile isn’t all-inclusive. They’re generally suited for men under 40 and women under 50 who have a healthy weight, don’t smoke and don’t have a heart condition, says Lisa Gill, editor of Consumer Reports’ Best Buy Drugs, based in Yonkers, N.Y.

The seven alternatives in the triptan category typically cost $20 to $43 per pill, Consumer Reports found, with prices for nasal-spray and injectable versions running even higher.

If sumatriptan doesn’t work to ease your pain, the magazine recommends trying rizatriptan, which has the brand name Maxalt, as the next step in migraine treatment.

Dr. Eric Wall, a family doctor in Seattle, says making the public more aware of the effectiveness of triptans for certain migraine sufferers is a valuable service.

“There still remains a remarkable number of patients who do have migraine headaches for whom triptans haven’t been used, and I’m not sure why,” he says. “I see them enough that it’s a bit surprising.

“I would agree in general that among the triptans there isn’t convincing evidence that one is superior to another. Since sumatriptan has been out there for a long enough period of time and available in generic form, it’s certainly more prudent to start with sumatriptan than others.”

Still, timing a patient’s triptan administration to within a few hours of the migraine onset is important to its effectiveness, says Wall, who’s also senior medical director for Qualis Health, a Seattle-based nonprofit health-care quality-improvement organization.

“A triptan clearly needs to be offered as a first-line trial for a patient with a migraine,” he says.

“The dilemma has been they’re more effective at the beginning of a headache. So when you’re coming to a physician’s office and you’re already in pain and had a day or two of headache, it’s not clear triptans will always be effective.”

Fighting headaches without drugs

Of course, not all headache relief has to come from a pharmacy. In some cases, physical therapy, biofeedback, yoga or stress-management techniques can help ease the pain or frequency of the problem.

Migraine sufferers also can help themselves by avoiding triggers such as certain food and drinks and getting enough sleep, Avitzur says.

Consuming beer, red wine or cheese may raise the likelihood of an attack. Even a break from fluorescent lights, TV screens or computer monitors might make a difference.

Avitzur advises migraine patients to keep a food and headache diary to try to identify their personal triggers.

Ask yourself, he says, “What was different about today possibly that could be contributing?”