Migraine and headache pain relief

From acupuncture and herbal remedies to OTC and prescribed medicines, we reveal which headache and migraine treatments actually work.
 
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01 .Headaches

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Over-the-counter (OTC) analgesic medications (paracetamol, aspirin, ibuprofen) are a fast, effective remedy for a headache. But if the headaches continue despite taking painkillers, you may have a medication overuse headache (MOH) – headaches caused by the very medications taken to treat them. At least one per cent of the population is estimated to suffer from this, and it’s now the third-most common headache after tension-type and migraine headaches.

Types of headache

Headaches generally fall into one of two categories:
  • Primary headaches include tension-type headaches, migraines and cluster headaches. Tension-type headaches are the most common. Their cause is unknown and may not simply relate to “muscle tension” as is popularly believed. Migraines are also reasonably common with about 15% of the population having suffered from them. Apart from moderate or severe throbbing head pain, which may be aggravated by movement, migraines can be associated with nausea, vomiting, photophobia (sensitivity to light) and/or phonophobia (sensitivity to noise). Women are up to three times more likely than men to suffer from migraine headaches. They’re most common when people are in their 20s and 30s, and tend to reduce in severity later in life.
  • Secondary headaches are caused by an underlying condition such as disease or injury, which needs to be identified and treated. Sinusitis, meningitis, encephalitis, stroke, brain tumours, dental problems or physical trauma such as whiplash or concussion can cause secondary headaches, as can a few too many drinks.

An under-recognised form of secondary headache is that brought on by medication overuse (previously known as “rebound” headache).

You should seek medical attention urgently if your headache:

  • Is much worse than, or different to, any headache you’ve had before
  • Starts suddenly or is aggravated by exertion, coughing, bending over or sexual activity
  • Is associated with persistent nausea and vomiting
  • Is associated with fever or stiff neck
  • Is associated with seizures
  • Is associated with recent head trauma or a fall
  • Is associated with changes in vision, speech or behaviour
  • Is associated with weakness or change in sensation
  • Is not responding to treatment and getting worse
  • Requires more than the recommended dose of OTC medications for pain
  • Is disabling and interfering with your work and quality of life.

See also our related article on children's painkillers.

 
 

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  • OTC analgesics such as aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Nurofen) or naproxen (Aleve) can temporarily relieve most tension-type headaches. Acupuncture, physical therapy, cognitive behavioural therapy and relaxation techniques may also help with frequent headaches.
  • Aspirin, paracetamol or NSAIDs (including ibuprofen, naproxen or diclofenac) can often successfully treat mild migraines. Your doctor may prescribe triptans, anti-emetics or ergotamine compounds for more severe migraines. Opioids (such as codeine or pethidine) are not recommended.

There are several prescription medicines that, taken daily, may help reduce the frequency and/or severity of migraines. Your doctor can determine what’s likely to help you, with options including beta blockers, some anti-depressants, anti-epileptic medications and calcium channel-blockers.

A specific headache diagnosis is the best way to obtain the right treatment. If a prescribed treatment hasn’t been successful, see your doctor again for a different prescription - or seek a second opinion.

Can painkillers really 'target pain'?

You may believe there are specific painkillers for different parts of the body: tension headache, migraine, back pain, neck pain, period pain and osteoarthritic pain.

But a closer look at the ingredients reveals they are often identical from product to product. For example, Nurofen Migraine Pain contains 200mg of ibuprofen, the same as Nurofen Back Pain, Nurofen Period Pain, Nurofen Tension Headache Pain and regular Nurofen Tablets. Panadol Back + Neck Pain contains the same 500mg of paracetamol as regular Panadol tablets, while the eight-hour sustained-release Osteo and Back+ Neck products both contain 665mg.

Different types of painkiller will act differently on pain:

  • Aspirin and other NSAIDs stop or reduce the production of prostaglandins – hormone-like substances that can trigger pain signals to the brain. They act in both the brain and the painful area to reduce pain and inflammation.
  • Paracetamolreduces the production of prostaglandins in the brain and central nervous system rather than at the site of pain, and has no anti-inflammatory effect.
  • Opioids, such as codeine, affect the brain’s responses to the pain message, rather than act on prostaglandins.

Painkillers act systemically rather than locally, so the drug is absorbed into your bloodstream and accesses most tissues in your body, not just the site of pain.

Alternative therapies for migraine

Feverfew and butterbur are herbal remedies that have been found to reduce the incidence of migraines – as have riboflavin (vitamin B2), magnesium (oxide or chelated) and coenzyme Q10 supplements. Our sister organisation in the US, Consumers Union, has put compiled a summary of supplements for migraines on its Consumer Reports on Health website.

A recent review of 22 studies found consistent evidence that acupuncture is also useful for treating acute migraine attacks and appears to be at least as effective as, or possibly more so than, preventative drug treatment, with fewer adverse effects.

headache tablets

The exact reason for MOH headaches is unclear, but it’s believed that regular use of painkillers may alter the processing of pain signals in the brain, making you more sensitive to pain and affecting how your brain naturally deals with it. In response, you take more painkillers, and the cycle continues. After a while, your body becomes used to the presence of a certain level of the drug, and stopping it results in withdrawal – and more pain.

MOH can arise from taking as few as 10 doses of painkillers for headaches in a month, depending on the individual and the type of painkiller used. Paracetamol, NSAIDs, codeine and triptans are all implicated. Interestingly, if you’re taking painkillers for pain other than headache – such as osteoarthritis - you’re less likely to suffer the MOH effect.

A diagnosis of MOH is made if headaches occur on more than 15 days per month for at least three consecutive months, in conjunction with the regular use of painkillers. Depression and anxiety are commonly associated problems and may complicate treatment.

The treatment of choice is complete withdrawal, under your doctor’s supervision. During this time, your headache often worsens before it gets better.

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