Do not take painkillers on more than 15 days a month, or combination painkillers on more than 10 days, or the headache may be caused by the medicine

If headaches keep coming and you take a painkiller every day, you may hurt more the more you take. The international headache classification calls this a medication-overuse headache, a headache brought on by the medicine itself. Headache on more than 15 days in a month, plus an ordinary painkiller on more than 15 days or a combination painkiller on more than 10 days, running past 3 months, is enough for the diagnosis. Most people improve after they stop the medicine they were taking too much of.

Cost

No money. You have to keep count of the days you take the medicine, and hold back from taking it whenever it is at hand.

Benefit

The 3rd edition of the International Classification of Headache Disorders, from the International Headache Society, gives the diagnostic criteria. The person already has a headache disorder, has headache on more than 15 days a month, and has regularly overused a medicine for headache for more than 3 months. For non-opioid painkillers such as acetaminophen, aspirin, and ibuprofen, the overuse line is 15 days a month or more. For combination painkillers the line is 10 days a month or more. A combination painkiller means more than a single class of pain-relieving drug combined, or a painkiller with an added ingredient such as caffeine, for example acetaminophen plus codeine. If you rotate several non-opioid painkillers, the days are added together. The classification states that epidemiological evidence from several countries shows that, among people with headache on more than 15 days a month, more than half have this kind of headache. Most patients improve after they stop the overused medicine, and treatment to prevent headaches also works better.

Notes

Pain tablets whose Chinese name includes the character for caffeine (咖) usually have caffeine added, so count them as combination painkillers, with a limit of 10 days. If the headache days in a month keep increasing, go to a neurology clinic. Do not only add more medicine. The grade is B because the classification gives a diagnostic threshold, not a controlled trial. The benefit is rated moderate, as a judgment: what you get back is fewer days of headache, and death is not part of it.

Sources · 2

1. Headache Classification Committee of the International Headache Society (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1):1-211. doi.org/10.1177/0333102417738202
2. ICHD-3 在线版 8.2 Medication-overuse headache（含 8.2.3、8.2.5）. ichd-3.org/8-headache-attributed-to-a-substan…