Headache every day? Your painkiller could be keeping the pain alive (opinion)

Written by: Serwaa Nyarko Benedicta Theresah

• Frequent painkiller use can trigger Medication Overuse Headache (MOH) and make headaches more persistent.

• Taking paracetamol or ibuprofen too often can create a cycle of temporary relief and recurring pain.

• People with frequent headaches should seek medical advice rather than continually increasing their painkiller use.

The problem starts when an occasional remedy becomes a routine.

Taking headache medicine too frequently can, in some people, contribute to Medication Overuse Headache (MOH), a condition in which frequent use of medication intended to relieve headaches can actually help perpetuate them. The result can be a frustrating cycle: a headache appears, medication provides temporary relief, the pain returns, and another dose is taken.

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The daily pill routine

For some people, the habit develops gradually.

Akosua Mansah, a final-year student in Accra, said frequent headaches during examinations led her to rely heavily on paracetamol.

“During exam periods, I kept a sachet of paracetamol in my bag every single day. I was taking two pills almost every afternoon. Eventually, I realised that if I didn't take them, my head would throb by mid-morning. It felt like my body was demanding the pills just to function normally,” she said.

A similar pattern can develop in the workplace.

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Evans Akwaboah, a bank teller in Kumasi, said long working hours and the conditions at his workplace contributed to regular headaches.

“Sitting under air conditioning all day while handling long customer queues constantly gave me dull headaches. My colleagues and I kept a bottle of ibuprofen in our desk drawers. It got to a point where I was swallowing four pills every workday just to survive my shift,” he said.

While individual experiences vary, regularly taking painkillers without addressing the underlying cause of recurring headaches can become a concern.

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Medication Overuse Headache is sometimes referred to as a rebound headache. It can occur when headache medicines are taken frequently, particularly by people who already experience recurring headaches.

Instead of providing a lasting solution, frequent use can contribute to a cycle in which headaches become more frequent or persistent.

The International Headache Society's diagnostic criteria generally distinguish between medication types. Headache occurring on 15 or more days a month in someone who regularly overuses acute headache medication for more than three months may meet the criteria for MOH, depending on the medication involved.

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For some medicines, overuse is defined as taking them on 10 or more days a month, while for simpler painkillers such as paracetamol and certain non-steroidal anti-inflammatory drugs, the threshold is generally 15 or more days a month.

This does not mean that taking a painkiller on one of those days will automatically cause MOH. Rather, the frequency and duration of use, together with the pattern of headaches and the type of medicine, are important factors that healthcare professionals consider.

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One of the biggest challenges is that the medication appears to work at first.

A person takes a tablet and the headache improves. When the pain returns, another tablet seems like the obvious answer. Over time, however, headaches may become more frequent, last longer or become harder to manage.

This can lead people to increase the frequency of their medication without realising that they may be contributing to the problem.

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The pattern can also mask the original cause of the headaches. Recurring headaches can be associated with several factors, including migraine, tension, poor sleep, dehydration, prolonged screen exposure, stress and other medical conditions. Treating the pain repeatedly without establishing why it keeps occurring can therefore delay appropriate care.

The risks also highlight the wider concerns surrounding self-medication.

Dr Frank Serebour, President of the Ghana Medical Association (GMA), has repeatedly cautioned the public about the misuse and unmonitored use of medicines.

Painkillers are widely available and, when used appropriately, can be effective. However, availability can sometimes create the impression that they are harmless regardless of how frequently they are taken.

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That is not the case.

Regular or excessive use of some painkillers can also cause other health problems. Depending on the medicine, prolonged or excessive use can affect the stomach, kidneys, liver or cardiovascular system. Combining medicines without understanding their active ingredients can also result in accidental overdosing.

For this reason, the fact that a medicine is available without a prescription does not mean it should be taken indefinitely.

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The first step is to pay attention to how often headaches occur and how frequently medication is being used.

Keeping a simple headache diary can help. Record when the headache begins, how severe it is, possible triggers, how much sleep you had, what you ate or drank and whether you took medication. This information can help a healthcare professional identify patterns.

People who regularly experience headaches or find themselves taking painkillers several times a week should consider speaking to a doctor or pharmacist rather than simply increasing their doses.

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Treatment for medication overuse headache may involve reducing or stopping the overused medicine, but this should be guided by a healthcare professional, particularly where certain medicines or frequent headaches are involved. Some people may also require treatment for the underlying headache disorder.

Simple measures can complement professional care. Staying adequately hydrated, getting regular sleep, taking breaks from prolonged screen use, eating regularly and managing stress may help reduce some common headache triggers.

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Most importantly, persistent or worsening headaches should not simply be treated with another tablet.

A headache that keeps returning deserves attention. If the medicine is becoming part of the daily routine rather than an occasional remedy, it may be time to stop and ask a more important question: what is causing the pain in the first place?