Migraine and Medication Overuse Headache: A Care Staff Guide

Headache is one of the most common complaints staff will hear, and most are harmless. Two situations deserve more attention: a headache with warning signs that needs urgent help, and a headache pattern that is being kept going by the painkillers used to treat it. NICE guideline CG150 covers the diagnosis and management of tension-type headache, migraine, cluster headache and medication overuse headache in people aged 12 and over. This guide pulls out what matters for care and support staff. It is general information, not clinical advice.

What migraine looks like

NHS hospital advice describes migraine as severe, throbbing pain, typically at the front or side of the head, often with nausea, vomiting and sensitivity to light or sound. Attacks can last hours or even days and can stop people doing their normal activities. Some people have an aura, such as visual disturbance, before the pain. Because the same symptoms can come from other conditions, a person with a new or changed headache pattern should be assessed by a clinician rather than labelled "a migraine" by default. NICE's most recent update to CG150, reviewed in June 2025, changed the preventive treatment options and stresses safety rules for topiramate in pregnancy and in women who could become pregnant.

Red flags: when to call 999 or go to hospital

NHS guidance published by trusts lists symptoms that call for urgent help. They include a sudden, extremely severe headache that peaks within seconds, a headache after a significant head injury, a high temperature, shivering, a stiff neck or a rash, any change in vision or speech, weakness or unusual sensations in the face, arms or legs, new confusion, drowsiness, fainting or loss of consciousness, and a red, painful eye. Staff should know this list and should never reassure someone out of seeking help when these signs are present. A headache after a fall also needs the approach in our guide to head injury and concussion, and sudden facial weakness, arm weakness or speech problems should be handled using the FAST stroke test.

Medication overuse headache

Medication overuse headache happens when regular use of acute headache medicines makes headaches more frequent. NICE's public information explains the thresholds: for triptans, opioids, ergots or combination painkillers, use on 10 days per month or more, and for paracetamol, aspirin or an NSAID such as ibuprofen, use on 15 days per month or more, for three months or more. NICE's patient material also notes that up to 1 in 50 people experience headaches caused by medication overuse and that women are about five times more likely than men to get them.

The key message for staff is that more painkillers is not the answer to more headaches. If a person is taking acute headache medicines on most days, do not simply keep supplying them. Raise it with the prescriber or GP, record how often each medicine is given, and make sure it is not being given by several routes at once, for example a prescribed painkiller plus over-the-counter stock under a homely remedies protocol.

What treatment involves

NHS Scotland's neurology guidance says that explanation is the key to managing medication overuse headache, and that treatment is withdrawal of the overused medicine. For simple analgesics and triptans, stopping abruptly is generally preferred, while combination painkillers and opioids such as codeine usually need a gradual reduction. The same guidance says headaches commonly get worse before they get better, with rebound headache lasting days or weeks, and that improvement after stopping may take around 7 to 10 days for triptans, 2 to 3 weeks for simple analgesics, and sometimes a few months. This is a clinician-led plan. Staff should not stop or change prescribed medicine themselves, but they play a major part in supporting someone through a difficult few weeks.

How care staff can help

• Keep a simple headache diary with dates, triggers, severity and every medicine taken, because patterns and overuse show up quickly on paper.
• Encourage regular meals, hydration, sleep and breaks from screens, and note triggers that the person identifies.
• Make sure the person knows when to ask for help, and that "worst headache of my life" is always a reason to call.
• Share the diary with the GP at reviews so preventive treatment can be considered where attacks are frequent.

Frequently asked questions

Can staff give paracetamol for every headache?

Only within the person's medicines policy and prescriber instructions. Frequent use is a prompt to review, not to continue indefinitely.

Is a migraine a reason to call 999?

Not by itself. A typical migraine can be managed with the person's usual plan, but red-flag symptoms or a sudden severe onset need urgent help.

Where can staff find training?

Medicines safety and recognising deterioration are good starting points. Browse the Learnsignal CPD hub for healthcare compliance courses.

Sources: NICE guideline CG150 and NICE public information on medication overuse headache; NHS Scotland Right Decisions neurology guidance; NHS hospital trust headache leaflets. This article is general information, not medical advice.