A senior neuroscience expert has highlighted a surprising and concerning side effect affecting people who regularly use common painkillers such as paracetamol, codeine, and ibuprofen. Dan Baumgardt, senior lecturer at the University of Bristol, reveals that general practitioners are frequently seeing patients who develop ongoing headaches linked to prolonged painkiller use.
Baumgardt explains that while these medications provide necessary pain relief, using them continuously for more than three months can lead to chronic, persistent headaches — a condition known as medication-overuse headache. “Patients often report headaches that start or worsen after regularly taking painkillers for three months or longer,” he says.
This condition affects individuals with migraines, tension headaches, or other chronic pain conditions like back or joint pain. Patients sometimes take multiple painkillers more frequently, unintentionally trapped in a cycle that exacerbates their headaches.
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Medication-overuse headache is estimated to affect 1-2% of people and is three to four times more common in women. The culprit, Baumgardt notes, is often the painkillers themselves, including opiates like codeine which can cause side effects such as constipation, drowsiness, nausea, hallucinations, and headaches.
It is not only strong opiate-based medications to blame. Common painkillers like paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen can also contribute. Some painkillers combine paracetamol with opiates — for example, co-codamol — increasing the risk.
Paracetamol is widely regarded as safe when used within recommended doses, which vary depending on age and weight. However, exceeding these limits or using it too often can be dangerous, sometimes even leading to liver failure. Moreover, regular paracetamol use alone has been linked to chronic headaches in some cases.
Other medications such as triptans, used to stop migraine attacks, may also contribute to medication-overuse headaches if used excessively.
Importantly, “overuse” doesn’t necessarily mean exceeding daily doses; headaches can develop if paracetamol or NSAIDs are taken on 15 or more days a month. With opiate-based meds, headaches may develop with even less frequent use, sometimes after ten days per month.
Baumgardt advises anyone needing long-term pain relief—even over-the-counter drugs—to consult a doctor. Susceptibility varies between individuals, so medical guidance is key.
Treatment usually involves gradually tapering off the painkillers under professional supervision and eventually stopping them completely. Those experiencing headaches on more than 15 days per month should see their GP promptly. Keeping a headache diary to track symptoms and medication use can help in diagnosis.
While the exact reason why painkillers can worsen headaches is not fully understood, awareness of this well-established link is vital. Baumgardt explains, “Many patients only discover that their pain was being fuelled by the medicines they relied on when they finally stop them.”