Medication and what is important

Seizure treatment

Seizure treatment

The methods of prevention without medication mentioned in the behavior section are extremely effective for many people and should always be used first. Although they often reduce the frequency and severity of migraine attacks, they usually cannot make it possible to live without headache medication. It is therefore of central importance that the patient knows exactly how he should take which medication and what he needs to pay particular attention to. One reason, of course, is that the pain should be eliminated as quickly and completely as possible. Another is that every medication also has side effects and treatment should therefore be as effective as possible. And another important reason: Painkillers can even cause headaches if they are taken incorrectly.

Headache caused by medication

If medication is used too frequently to treat headaches, a so-called MÜK (medication overuse headache) can occur. We know from health insurance data that around 160,000 people in Germany have to undergo inpatient treatment every year because of a medication overuse headache. It is estimated that around 1 to 2 percent of the population in Germany is affected by this problem - that's 800,000 to 1.6 million people.

It is a diffuse and pulsating persistent headache, often without the typical accompanying symptoms of migraine. Taking painkillers and migraine medications too frequently can also lead to the frequency of migraine attacks increasing, the migraine attacks lasting longer, being more intense and responding less well to medication. The suspicion that the headache treatment itself is triggering the headache must always be considered

  • Headache medication is taken for more than 3 months on more than 10 days per month,
  • more than 15 headache days per month and
  • headache relief occurs within two months of taking a break.

Many people don't know it, others don't want to admit it

Very few people realize that their headache could have increased in frequency, persistence and duration as a result of regularly taking headache medication. On the contrary, those affected are constantly trying to find the one medication that will solve all their symptoms. For this reason, medications are changed very often and new substances are tried out.

There is often a fear of effective medications because of the assumption that what works well must also be strong and stressful. Some patients prefer to take a moderately effective medication very often. They believe that if it doesn't help well, then it can't be strong and can cause dangerous side effects. However, the opposite is true. Potent migraine medications like the triptans act like a security key without much force in a security lock. They are more tolerable than commonly taken so-called “mild” and only moderately effective painkillers.

At first, many patients do not believe that their headaches are being alleviated by the medication: They have learned that eliminating them with certain regularity leads to a bad headache after a few hours, and taking headache medication leads to at least a temporary elimination of the pain - at least for an hour. Many patients don't even dare to go out on the street without headache medication. However, some patients sense the connection between their suffering and the medication they are taking. Responsible pharmacists who recommend a visit to the doctor or even a reduction in painkillers when purchasing medication are then avoided. To keep up appearances, some patients go to Pharmacy A on Monday, Pharmacy B on Wednesday and Pharmacy C on Saturday.

The immediate reason for continuing to take medication is the withdrawal headache, which sets in as the medication effects wear off. In 90 percent of patients, this headache is of moderate to severe intensity. It is accompanied by nausea, vomiting, fear and restlessness, circulatory problems, dizziness and sometimes even fever. Taking one or two tablets often relieves this torment - unfortunately only temporarily for the next few hours - and at the same time causes it to slowly but steadily get worse from time to time.

Medication break in the clinic

In the case of an MÜK (medication overuse headache), a so-called medication break is now carried out; in the English-speaking world, the beautiful word “drug holiday” was coined for this. In the first phase of treatment, we explain to the patient in detail about the mechanisms behind the development of headaches and the effects of long-term medication use. In addition, the patient will of course be informed in detail about further treatment during the medication break.

A medication break usually has to be carried out in an inpatient setting, as so-called rebound or transition headaches usually lead to the need to take painkillers again during the medication break at home. In specialized clinics - such as the Kiel Pain Clinic - the long-term use of headache medication is stopped from one day to the next. To eliminate the transition headache that follows, the patient is given medication that makes the used messenger substances available again. For this purpose, an infusion treatment lasting several days is usually carried out. In addition, the patient is taught concepts in an intensive behavioral medicine program to prevent headaches through non-medicinal measures. In addition, the patient also learns how to use headache medication appropriately, so that the person affected is then able to use medication in a targeted manner and in the correct dosage. However, the focus is on behavioral health prevention of headaches without medication.

So that it doesn't come to that

If you follow the following critical thresholds, you can largely prevent medication overuse headaches:

Threshold No. 1: Timing of income behavior

  • Do not take headache medication more than 10 days per month.

Threshold #2: Headache Frequency

  • Do not self-medicate if you have headaches more than 10 days per month. Go to the doctor!

Threshold #3: Analgesic preparation and type

  • Do not take medications with two or more active ingredients (and no opioid analgesics for migraines or tension-type headaches). Adding substances to the actual active ingredients of the painkiller (for example, codeine, caffeine, ethenzamide, thiamine, quinine, salacetamide and others are added) does not increase their effectiveness against headaches, but increases the risk of side effects and the risk of psychological habituation, so increasing the dose and thus the constant headache becomes very likely. Patients who were treated for this problem at the Kiel Pain Clinic showed that the more active ingredients there are in a headache tablet or the more different active ingredients are contained in medications taken at the same time, the longer and more difficult the withdrawal from painkillers is.