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Can Non-Prescription Pain Medication Cause Headaches?
January 22, 2003
Maia Szalavitz
The New York Times neglects important research

The New York Times Magazine reported recently (01/12) that over-the-counter (OTC) medications like Tylenol (acetaminophen), Advil (ibruprofen) and Excedrin Migraine (which contains aspirin, acetaminophen and caffeine) may actually be a major cause of headaches rather than a source of relief.

The magazine claimed that 4-5% of Americans suffer from "chronic daily headache" and that for half of these people, the problem was caused by over-use of non-prescription headache medicines.

But the story neglects important research which found that prescription anti-headache medications, called triptans and ergots lead to medication-induced headache much more quickly than OTC medications.

Medication-induced headaches appeared within 1.7 years for people taking triptans, within 2.7 years for ergots, but took nearly five years (4.8 to be precise) to occur with over-the-counter drugs, according to a study published in the October 8, 2002 issue of Neurology.

It also took lower doses of the prescription medications to produce the problem than it did with OTC medications. On average, those who developed medication-induced headache took triptans 18 times a month before they developed the condition, while OTC medication users had to take 114 doses per month to make their condition worse.

So why would people take these medications for so long if they weren't suffering in the first place? The article suggests that they were looking for a "quick fix" and became "addicted" to the drugs. But the obsession with the substance, compulsive use and "high" which mark genuine addiction don't occur with OTC medications.

All the case histories in the story involve people with headaches who took more medication over time to treat their pain, not people who began longing for Tylenol bliss. And no one seemed to develop headache from taking aspirin to avoid heart attack or Advil for arthritis. If these OTC medications were the sole cause of the problem, it would seem probable that they would cause headaches in people who weren't treating headaches - but the research finds that it doesn't, according to a review published in the British Medical Journal in 1995.

Over the counter painkillers clearly aren't the solution - and seem to be part of the problem - for many people with serious headaches. But proposing that they are addictive, bemoaning quick fixes and not mentioning serious problems with alternative prescription medications isn't going to help, either.

If the theory mentioned in the article is correct, in fact, and chronic headaches are a neuropathic problem in which the brain, either by itself or abetted by drugs, begins to interpret non-painful signals as pain, a quick fix of early, effective treatment might be just what is needed to avoid setting this cycle in motion.



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