How to Reduce the Risks of Pain Medications for Headaches

According to the World Health Organization (WHO), headaches are reported to be one of the most common disorders of the nervous system. Globally, it is estimated that nearly everyone has an occasional headache and that over 50% of the world’s population are regularly plagued by them. For many sufferers, headaches are not just an occasional occurrence and may not even be reported to healthcare providers due to the sad, untrue perception that they should be a regular expectation of life.

Experts approximate that 15% of the world’s population is having some type of headache on any given day. It is also estimated that people suffering from headaches have increased compared to prior generations.?

Not only are headache disorders painful, they are disabling and contribute to substantial personal suffering, impaired quality of life and financial cost. WHO reported that the Global Burden of Disease Study ranked headache disorders as the third highest cause worldwide of years lost due to disability. Headaches should not be viewed as an expected part of life and should not be simply tolerated. Sufferers of headaches should be assessed with the goal of alleviation and prevention.

Types of Headaches

Headaches can be classified into two major categories, primary and secondary.?

• A primary headache has specific qualities but does not necessarily have an underlying cause that can be pinpointed.?
• A secondary headache is the result of another condition or specific action. For example, a sinus headache due to sinusitis/congestion would be a secondary headache.?

Though there are many different headache types, here we will focus on WHO’s top three: tension, migraine and medication overuse.

1. Tension: Tension-type headaches are the most common type of primary headache disorder and affect over one-third of all men and over one-half of women. Statistics show that up to one in 20 adults actually deal with a tension headache nearly every single day. They are often described as a feeling of ‘pressure’ or ‘tightness’ in the shape of a band around the top of the head. For many, it spreads from, or to, the cervical spine (neck). They can last from hours to days.??
2. Migraine: Migraines are a specific primary headache disorder with special qualities (eg. not every bad headache can be classified as a migraine). One in seven adults are affected regularly by migraine headaches. Once they begin, these headaches are often a life-long affliction characterized by recurring attacks that could occur in varied frequency ranging from one or more a week, month or year. They are thought to be hormonally influenced but no specific cause has been found. They tend to be located on one side of the head with an extreme pulsating quality and moderate to severe intensity. Attacks can last hours or days and are often accompanied by other symptoms: prodromal vision of flashing light (scintillating scotoma), sensitivity to light and sound, fatigue, nausea and even vomiting.?
3. Medication Overuse: Chronic and excessive use of medications to treat headache or other chronic pain conditions can, ironically, lead to medication-overuse headaches (MOH). Also called ‘analgesic rebound headaches’ these are one of the most recognized secondary headache disorders. They are rated by WHO as being one of the top three headache types with public health importance since they are responsible for ill-health and disability in high numbers of the population. According to Cleveland Clinic, these are a vicious cycle of having headaches, taking more and more pain medications in an effort to relieve them, but only inciting the result of daily or nearly daily headaches where the drugs being taken become less and less effective. These headaches are said to be indistinguishable from the original headache that they were taken to relieve. This can lead to overuse and a feeling of helplessness. MOH typically occurs in patients with a background of primary headaches like migraine or tension. However, it may also occur when analgesics are used for other chronic pain conditions such as low back pain or fibromyalgia.?

Adverse Effects of Pain Medications

Many individuals strive to get through ongoing headaches with the help of painkillers. Pain medications that are only taken occasionally and at recommended doses typically do not pose an issue. However, more than 30 million Americans misuse over-the-counter (OTC) pain medications on a daily basis. Overuse is a significant problem. The most common type of OTC painkillers are non-steroidal anti-inflammatory drugs (NSAIDs). Commonly referred to as ‘aspirin’ or ‘ibuprofen’ products, they are often used to relieve symptoms for conditions such as: headaches, menstrual pain, sprain/strain injuries, arthritis or back pain.

Just as with certain prescription drugs, OTC pain reducers can pose significant health issues if misused or overused. Long-term use of NSAIDs may cause numerous adverse effects that include but are not limited to gastrointestinal, cardiovascular and renal (kidney) risks. A majority of peptic ulcers and hospitalizations (that are not caused by a direct bacterial infection of Helicobater pylori), are from chronic NSAID use. One study showed that endoscopy procedures in up to 30% of arthritis patients demonstrated the development of significant GI complications, like ulcers, after NSAID consumption.

Even other common OTC pain medications, such as acetaminophen (which is not an NSAID), pose potential long-term harm to the kidneys and GI system and both ibuprofen and acetaminophen also have potential short term side effects that can affect quality of life such as: upset stomach, nausea, vomiting, headache, diarrhea, constipation, dizziness or drowsiness. Consumers need to be aware that products with these ingredients come under different brand names and that there may also be ‘combination products’ which contain multiple types of analgesics. Reading all labels carefully will help people to not inadvertently take more than is recommended.

Managing Headaches Naturally

Many common headaches can be addressed naturally and help patients reduce their consumption of potentially harmful OTC and prescription medications. Medication overuse headaches are common and regarded as a major cause of disability in adults under 50 years of age.?

Lifestyle changes are extremely beneficial and include a variety of areas that patients can address on their own.

• Reducing stress: stress can contribute to muscle tension which then in turn can contribute to joint pain and headache. Finding time for meditation, yoga or other activities that will help you decompress mentally will also help your physical state.
• Dietary mindfulness: watch your food and drink carefully for elements that may trigger your headache. Some chemical additives/preservatives, for example MSG, have been linked to triggering migraines in susceptible people.
• Sleep: too much or little sleep has long been correlated with headache symptoms. Strive for regular sleep patterns and ample quality hours of sleep each night.
• Exercise/Stretching: staying strong and flexible can help diminish the muscular component of headaches. Work to create balance in the flexor and extensor muscles and stretch to help alleviate spasms that can lead to a cycle of affected joints and tension-type headaches.
• Posture/Ergonomics: Foundational causes of stress in the muscles and joints can often be related to posture and the hours of ill-positioning that can occur at a workstation that is not set up to compliment your body dimensions ergonomically.

In addition to personal changes, chiropractic care has also been shown to be beneficial. Headache patients actually make up a substantial proportion of the caseload in chiropractic offices. Evidence from the Journal of Manipulative Physiological Therapeutics suggests that chiropractic care improves cervicogenic headaches (coming from the neck) as well as migraine. The anatomy of the head and neck and imbalances due to posture or ergonomics are all significant contributors to headaches. Tension headaches in particular have components in the musculature of the mid-back, shoulders and all the way through the neck and muscles of the head. This type of extreme muscular tension may also disrupt the joints of the spine where they attach to. Much like a chicken and egg loop, posturing and joint dysfunction can lead to muscle tension and muscle tension can reduce the stability and alignment of the spinal joints cumulatively resulting in headache cycles.

Doctors of chiropractic (DCs) have expertise in neuromusculoskeletal anatomy to naturally affect the root cause of many headache types and work to help prevent relapses. Cervicogenic headaches, migraines and secondary headaches such as those experienced after whiplash injury, slips/falls and poor posturing all have potential to respond extremely well to conservative care and lifestyle changes.