Headache From NSAIDS (nonsteroidal anti-inflammatory drugs) 2023
Lots of people with Migraine or Tension Type Headache have no specific diagnosis ever made by a doctor. They see it as that they just have a “headache” occasionally. The problem is that at some time in their life there me be stress, poor sleep, overwork, or missed meals.
These habits can be a lead in to a long stretch of daily headaches, with Migraine features-one-sided headaches which are severe, and that come with sensitivity to light and sound, and nausea and vomiting.
This is a set up for developing Medication Overuse Headache and the number one drug people take to do this is caffeine, and the number 2 drugs are NSAIDS.
This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, migraine textbook author, podcaster, YouTube video producer, and blogger.
The Headache Problem With NSAIDS (non-steroidal anti-inflammatory drugs) is that over treating with them leads to severe, chronic headaches. This overtreatment pattern leads them into Medication Overuse Headache, a syndrome caused by taking too much medication.
Related questions.
What are the names of commonly used NSAIDS?
The generic name of Advil or Motrin is ibuprofen which comes as 400 mg, 600 mg, 800 mg as a doctor’s prescription, or 200 mg over the counter.
Naproxen comes as 250 mg, 375 mg, or 500 mg as a doctor’s prescription or 200 mg over the counter as Aleve or Naprosyn, It lasts 12 hours.
Other similar NSAIDs are miloxicam, toradol, and indomethacin.
Do other over the counter pain killers cause the same problem?
It happens with aspirin, Excedrin, BC Powders, and Tylenol (acetaminophen) also, but these drugs aren’t NSAIDS.
Read my Mini Book on Migraine Here.
What is the treatment of Medication Overuse Headache?
The person with headaches must get off the medications they are taking, either by detoxing slowly over a few weeks, or all at once and getting it over with.
These persons with Medication Overuse Headache may be safely and efficiently treated by seeing a Neurologist or a Headache doctor.
The patient should be instructed to do the Migraine lifestyle which is:
7-8 hours of sleep a day
Three meals a day.
Regular holidays and relaxation
Aerobic exercise 3-4 days a week
No caffeine.
The Headache doctor may start a daily preventive drug like amitriptyline, Depakote, propranolol, or topiramate and give a week or 2 of prednisone. The doctor may offer DHE nasal spray or Timolol eye drops for acute therapy. The doctor may start one of the ne CGRP preventive drugs.
Is there a neurologic work up for Headache and should that be done?
All persons with severe chronic headache should consider seeing their general doctor or a neurologist and consider getting a CAT or MRI scan of their brain and some general lab to check their health. Hopefully these tests will be normal.
What about dealing with all my stress or trouble sleeping?
Migraine is comorbid (means 2 health problems occur together) with depression, generalized anxiety disorder, and panic disorder. Attention to these problems, if present, often require counselling, and the use of psychiatric drugs.
Once I detox off my drugs what do I do?
All persons need to limit painkiller use in the future. Use of these drugs more than 15 days a month can aggravate headache or cause daily headache. The general rule is to limit acute medication for Migraine to only 2 days per week.
This problem is worse for patients who have inherited the migraine gene and have had mild migraines before which hasn’t been for them a big problem, so a diagnosis was never made, or they have migraine aliases (words that really mean Migraine) like sinus headache, hungry headache, or menstrual headache.
Commonly the patient has lived with these not so bad, mild headaches for years but then they get into trouble when they start treating frequently with NSAIDS, taking multiple doses every day, and then they end up in the ER or a headache doctor’s office with severe headaches.
Persons with Migraine need to know, “List of Issues For Migraine prevention” on my website, www.doctormigraine.com. Please click here to read.
The treatment for Medication Overuse Headache is to educate and detox the affected patient. Then in the future they may use one of the triptans, still the best acute therapy drugs for Migraine, stay with their preventive drug, and do the Migraine lifestyle.
Medication Overuse Headache occurs in 3-4% of persons in the world but comprises 80-90% of all new patients to a headache practice.
Do NSAIDS cause any other medical problems?
Use of NSAIDs for headache can also cause or aggravate heartburn or GERD (gastroesophageal reflux disorder) which will usually improve after the patient quits taking so much medication, after they see their headache doctor and improve.
Check out my Big Book on Migraine Here.
This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.
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All the best.
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Britt Talley Daniel MD
