Half of those referred to the five specialist headache clinics in Ireland have to get their medication overuse headache sorted out before they can help treating their migraine, according to Patrick Little, CEO of the Migraine Association of Ireland.
“If you have headaches regularly and are self-medicating – buying over-the-counter (OTC) medication to treat it – you need to talk to your pharmacist,” he says. “You should only be taking headache medication [no more than] six to eight days’ a month, the experts say, in order to avoid putting yourself at risk of what’s called medication overuse headache (MOH),” Patrick says.
This kind of headache is described as a dull, constant, low-intensity ache and only affects those who suffer from migraine. The CEO believes that many migraineurs who also have medication overuse headaches have difficulty admitting how often they take OTC painkillers.
“We had a phone-in support group one time, and because people were speaking from their own homes they were willing to be more honest,” he says. “We were actually shocked at the level of medication people were taking. It’s a big, hidden problem, really.”
Taking too many painkillers is not an easy cycle to break, he says, but going over six to eight days’ a month taking medication is not advised.
“Generally, the idea is when you get a full-on migraine attack to hit it hard (with a combination of prescribed medications) – but not to be taking medication when you don’t have a severe attack,” explains the CEO.
Free headache clinics
The five headache clinics in Ireland – in Beaumont Hospital, Cork University Hospital, the Mater, St Vincent’s and University Hospital Galway – are open to public patients to attend, but you do need a referral from your GP.
“The sooner people get help the better, because then they usually get onto the correct, monitored treatment,” he advises.
Treatment
What does treatment for this kind of headache involve? “The only way of treating people in Ireland is withdrawing them from the medication they are on,” the CEO says. “They are usually treated at home. In Denmark, where they’d be regarded as being very good at treating headache, they run psychological-type courses to prepare people to give up the painkillers. Depending on the situation, the person may be admitted to hospital for a week or two and put onto new medication.”
One of the reasons for this is that when people come off the (generally codeine-based) medications, their headaches usually get worse for a period. “This can be tough,” he says, “but people are usually withdrawn from the medication slowly, as it may be difficult to stop taking these painkillers. We in the Migraine Association of Ireland try to support people to get them to recognise that the headache may get worse for a short period, but then it’ll get better when they get onto proper medication.”
Focus on pharmacies
In September, the focus of Migraine Awareness Week(10 to 17 September) is “migraine and pharmacies”. “We are trying to make pharmacists and pharmacy staff more aware and more alert to people coming in and buying painkillers, so we’ll be running a special campaign this week. We will be having a webinar event for pharmacists too, with experts available.”
On the ground
Esther Tomkins is a migraine specialist nurse at the headache clinic at Beaumont Hospital, so she comes across MOH frequently. “The person has this dull headache and reaches for painkillers, thinking: ‘I can’t get through the day without taking painkillers.’ Or: ‘It’s going to escalate into a more severe attack, so I’ll take the painkillers to stop that happening,’” she says.
Educating patients about this type of headache is vital, she believes. “Patients need to be aware of it. Half of all patients we see at the headache service in Beaumont would have a component of MOH when they first present at the clinic. Taking the OTC medication contributes to the headache, because they cause a rebound effect to the migraine headache.”
Headache specialists see this kind of headache in patients who, in the past, had episodic migraine. “Unfortunately they start to have more frequent headache and more frequent migraine, and taking the extra painkillers actually becomes a contributing factor to worsening the migraine headache.”
She agrees it is complicated, as patients may take painkillers thinking they will ward off an episode of migraine. “That’s why education is so important. Codeine-based drugs are probably the ones that have the most risk of leading to problems. We would advise patients to combine their (prescribed) migraine medication with a non-steroidal anti-inflammatory, rather than take any codeine-based drugs. Some patients, however, will just want to take those medications.”
If this is just occasionally, that’s fine, she adds, but more chronic patients often take codeine-based medication very frequently. “That’s because they think painkillers are the right treatment, but they aren’t. This type of headache is a serious enough condition, affecting a large number of patients, and it is good that patients are becoming more aware it is a worsening component to headache.”
See www.migraine.ie for more.
Specialist nurse’s advice
So what’s her advice as a specialist nurse? “It’s the patients that are experiencing headache on more than 15 days in the month that are the most susceptible to MOH,” she says. “Maybe they are treating their headaches on three or four days every week – or even every day. We want to educate them about MOH and inform them that they should limit the amount of painkillers that they take to no more than two days’ a week – or six to eight days’ a month, depending on the person,” advises Esther.
People may get into this MOH vicious cycle because it takes too long to get a migraine diagnosis, she says. “If they get a proper diagnosis quickly, proper education, get onto the right migraine preventative medication that works for them and the right treatment, the incidence of MOH in this country will fall off.
“That’s because if the preventive medication works on the neurons inside the brain this will also alleviate a lot of the dull daily headaches, so therefore the patient doesn’t need to reach for the painkillers.”
The majority of patients don’t want to be reaching for them, she believes. “They don’t like taking them. We find once they understand the painkillers could be contributing to the daily headache they are experiencing they take the guidance very well. They will then restrict the amount of painkillers they take because they know that they can still take an acute treatment cocktail (several medications together) when they get severe migraine,” explains Esther.
Treatment involves keeping a headache diary and grading headaches on a pain scale of zero to 10. Patients are then helped to manage the headaches that score under five on the pain scale in other ways than with painkillers.
“We talk about lifestyle, wellness, mindfulness, light exercise, regular diet and good hydration to manage symptoms better,” she says. “The more severe attacks would, of course, be treated. After that we would introduce the preventive drug treatment for their migraine as well.”
A lot of thought goes into a treatment plan, she says, but patients need the support of their GP as well as the headache clinic in order to manage their migraine better. Esther advises seeking help from your pharmacist if you think you have a problem. “They are a very valuable community resource,” she says.
It is also worth noting that people who are using prescribed migraine medications by their doctors can also get medication overuse headache from overusing these migraine drugs, with triptans often being one of the more “at risk” medications.
Depression and bipolar disorder
Aware, the organisation providing support, education and information services around depression and bipolar disorder is running its popular “Life Skills Group” and “Relatives and Friends” programmes nationwide this September and October.
The Life Skills Group programme and Life Skills Online will equip people with the tools to cope with the stresses of everyday life. This course runs for nine hours over six weeks.The Relatives and Friends programme for those supporting a loved one experiencing depression or bipolar disorder, is held for six hours over four weeks.Both courses are free* to attend, evening courses and registration is now open. Online registration for the programmes is now open at www.aware.ie and places are available to anyone over 18.*The Aware education programmes are free to attend, with a refundable €30 booking deposit in place to ensure participants who really want to book a place have the opportunity to do so. The booking fee will be refunded by contacting Aware once all modules in the course have been completed. Reduced booking fees are available for students, the unemployed, OAPs or those in possession of a medical card.
Lyme disease rally at Leinster House
People who have developed Lyme disease, the disease spread by infected ticks, are holding a rally to highlight their plight at Leinster House on 26 September from 11am to 3pm.
Half of those referred to the five specialist headache clinics in Ireland have to get their medication overuse headache sorted out before they can help treating their migraine, according to Patrick Little, CEO of the Migraine Association of Ireland.
“If you have headaches regularly and are self-medicating – buying over-the-counter (OTC) medication to treat it – you need to talk to your pharmacist,” he says. “You should only be taking headache medication [no more than] six to eight days’ a month, the experts say, in order to avoid putting yourself at risk of what’s called medication overuse headache (MOH),” Patrick says.
This kind of headache is described as a dull, constant, low-intensity ache and only affects those who suffer from migraine. The CEO believes that many migraineurs who also have medication overuse headaches have difficulty admitting how often they take OTC painkillers.
“We had a phone-in support group one time, and because people were speaking from their own homes they were willing to be more honest,” he says. “We were actually shocked at the level of medication people were taking. It’s a big, hidden problem, really.”
Taking too many painkillers is not an easy cycle to break, he says, but going over six to eight days’ a month taking medication is not advised.
“Generally, the idea is when you get a full-on migraine attack to hit it hard (with a combination of prescribed medications) – but not to be taking medication when you don’t have a severe attack,” explains the CEO.
Free headache clinics
The five headache clinics in Ireland – in Beaumont Hospital, Cork University Hospital, the Mater, St Vincent’s and University Hospital Galway – are open to public patients to attend, but you do need a referral from your GP.
“The sooner people get help the better, because then they usually get onto the correct, monitored treatment,” he advises.
Treatment
What does treatment for this kind of headache involve? “The only way of treating people in Ireland is withdrawing them from the medication they are on,” the CEO says. “They are usually treated at home. In Denmark, where they’d be regarded as being very good at treating headache, they run psychological-type courses to prepare people to give up the painkillers. Depending on the situation, the person may be admitted to hospital for a week or two and put onto new medication.”
One of the reasons for this is that when people come off the (generally codeine-based) medications, their headaches usually get worse for a period. “This can be tough,” he says, “but people are usually withdrawn from the medication slowly, as it may be difficult to stop taking these painkillers. We in the Migraine Association of Ireland try to support people to get them to recognise that the headache may get worse for a short period, but then it’ll get better when they get onto proper medication.”
Focus on pharmacies
In September, the focus of Migraine Awareness Week(10 to 17 September) is “migraine and pharmacies”. “We are trying to make pharmacists and pharmacy staff more aware and more alert to people coming in and buying painkillers, so we’ll be running a special campaign this week. We will be having a webinar event for pharmacists too, with experts available.”
On the ground
Esther Tomkins is a migraine specialist nurse at the headache clinic at Beaumont Hospital, so she comes across MOH frequently. “The person has this dull headache and reaches for painkillers, thinking: ‘I can’t get through the day without taking painkillers.’ Or: ‘It’s going to escalate into a more severe attack, so I’ll take the painkillers to stop that happening,’” she says.
Educating patients about this type of headache is vital, she believes. “Patients need to be aware of it. Half of all patients we see at the headache service in Beaumont would have a component of MOH when they first present at the clinic. Taking the OTC medication contributes to the headache, because they cause a rebound effect to the migraine headache.”
Headache specialists see this kind of headache in patients who, in the past, had episodic migraine. “Unfortunately they start to have more frequent headache and more frequent migraine, and taking the extra painkillers actually becomes a contributing factor to worsening the migraine headache.”
She agrees it is complicated, as patients may take painkillers thinking they will ward off an episode of migraine. “That’s why education is so important. Codeine-based drugs are probably the ones that have the most risk of leading to problems. We would advise patients to combine their (prescribed) migraine medication with a non-steroidal anti-inflammatory, rather than take any codeine-based drugs. Some patients, however, will just want to take those medications.”
If this is just occasionally, that’s fine, she adds, but more chronic patients often take codeine-based medication very frequently. “That’s because they think painkillers are the right treatment, but they aren’t. This type of headache is a serious enough condition, affecting a large number of patients, and it is good that patients are becoming more aware it is a worsening component to headache.”
See www.migraine.ie for more.
Specialist nurse’s advice
So what’s her advice as a specialist nurse? “It’s the patients that are experiencing headache on more than 15 days in the month that are the most susceptible to MOH,” she says. “Maybe they are treating their headaches on three or four days every week – or even every day. We want to educate them about MOH and inform them that they should limit the amount of painkillers that they take to no more than two days’ a week – or six to eight days’ a month, depending on the person,” advises Esther.
People may get into this MOH vicious cycle because it takes too long to get a migraine diagnosis, she says. “If they get a proper diagnosis quickly, proper education, get onto the right migraine preventative medication that works for them and the right treatment, the incidence of MOH in this country will fall off.
“That’s because if the preventive medication works on the neurons inside the brain this will also alleviate a lot of the dull daily headaches, so therefore the patient doesn’t need to reach for the painkillers.”
The majority of patients don’t want to be reaching for them, she believes. “They don’t like taking them. We find once they understand the painkillers could be contributing to the daily headache they are experiencing they take the guidance very well. They will then restrict the amount of painkillers they take because they know that they can still take an acute treatment cocktail (several medications together) when they get severe migraine,” explains Esther.
Treatment involves keeping a headache diary and grading headaches on a pain scale of zero to 10. Patients are then helped to manage the headaches that score under five on the pain scale in other ways than with painkillers.
“We talk about lifestyle, wellness, mindfulness, light exercise, regular diet and good hydration to manage symptoms better,” she says. “The more severe attacks would, of course, be treated. After that we would introduce the preventive drug treatment for their migraine as well.”
A lot of thought goes into a treatment plan, she says, but patients need the support of their GP as well as the headache clinic in order to manage their migraine better. Esther advises seeking help from your pharmacist if you think you have a problem. “They are a very valuable community resource,” she says.
It is also worth noting that people who are using prescribed migraine medications by their doctors can also get medication overuse headache from overusing these migraine drugs, with triptans often being one of the more “at risk” medications.
Depression and bipolar disorder
Aware, the organisation providing support, education and information services around depression and bipolar disorder is running its popular “Life Skills Group” and “Relatives and Friends” programmes nationwide this September and October.
The Life Skills Group programme and Life Skills Online will equip people with the tools to cope with the stresses of everyday life. This course runs for nine hours over six weeks.The Relatives and Friends programme for those supporting a loved one experiencing depression or bipolar disorder, is held for six hours over four weeks.Both courses are free* to attend, evening courses and registration is now open. Online registration for the programmes is now open at www.aware.ie and places are available to anyone over 18.*The Aware education programmes are free to attend, with a refundable €30 booking deposit in place to ensure participants who really want to book a place have the opportunity to do so. The booking fee will be refunded by contacting Aware once all modules in the course have been completed. Reduced booking fees are available for students, the unemployed, OAPs or those in possession of a medical card.
Lyme disease rally at Leinster House
People who have developed Lyme disease, the disease spread by infected ticks, are holding a rally to highlight their plight at Leinster House on 26 September from 11am to 3pm.
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