Painkillers (analgesics) are by far the highest-selling drug class in Germany. International studies suggest that medication overuse headache affects about 3-4 million people in Europe. Although not enough studies have been done to say for sure, the sheer volume of pain medication used by the population suggests that overuse is a major public health problem in this country.

Medication overuse headache in a person using triptans presents with a pulsing, often one-sided headache. Medication overuse headache associated with ergotamines, conventional analgesics and combination products is usually described as a pressing pain on both sides of the head. Other associated symptoms include dizziness, difficulty concentrating, fatigue and poor sleep. Migraine patients may then go on to develop headaches that combine elements of migraine and tension-type headache. Medication overuse is very common in people with migraine who have headaches on more than 15 days a month.

Rebound headache is the reason behind the frequent medication use. People with headache often take painkillers preemptively to head off the next attack, which increases their risk of taking pain-relieving drugs on too many days in a month. If any of the following applies to you, seek medical assistance: you switch from monotherapy (one active ingredient) to combination products (containing two or more active ingredients) – you use headache medication on more than 10 days per month – you experience headaches on more than 14 days per month.

Paradoxical but true: medications you take for headache relief can themselves cause headaches. A central nervous system (CNS) control mechanism is behind this phenomenon. If you take painkillers consistently for a long period, the CNS up-regulates its pain sensitivity to get pain perception back to a ‘normal’ level. That’s why stopping pain medications after long-term use may trigger an agonizing rebound (withdrawal) headache.

Taking painkillers to treat that pain can catch a person in an endless cycle of worsening pain and increasing medication use, ultimately resulting in medication overuse headache.

Pain medications mediate their effect by occupying receptors. Heavy use of painkillers makes the receptors less sensitive. But in this situation, any drop in the medication levels in your blood sends a false pain signal to your brain. Your pain threshold falls and your body interprets otherwise harmless stimuli (in biochemical terms: receptor states) as pain. Medication overuse headache is less about the dose and more about how often you take pain medications.

Medication overuse headache is a seriously disabling condition associated with an average of 25 lost workdays per affected person per year. To prevent medication overuse headaches, consider limiting your use of acute medication. Applying the 10-20 rule helps. It says you should not take painkillers on more than 10 days a month. A daily dose is not specified. Combination products are more likely to trigger a medication overuse headache and are best avoided altogether.

80% of sufferers have chronic daily headache. 20% of suffers have a headache on more than 20 days a month.

The symptoms become chronic when certain behavioral factors and changes in the pain perception system coincide (see 'Headache' section above). The onset of pain puts you in fear of the next attack. Since experience shows that taking medication as soon as possible helps, drug-free intervals get shorter and shorter. At the same time, your pain receptors become more and more sensitive, and the pain increases in frequency until it ends up never going away at all.