Doctors face headache of kids overdoing OTC painkillers

The teenager was taking six over-the-counter analgesics a day, and the headaches that had once been only occasional visitors were making her life a daily hell. So Allan Bernstein, MD, chief of neurology at Kaiser Permanente in Santa Rosa, Calif., had to convince her that the pills were part of the problem and it was time to wean her off of them.

"I said we could cure her headache, but it takes a lot of educational time to explain that when you stop taking the medicine, the headaches get worse and it's going to take a while before it all goes away," he said.

Headache experts have long acknowledged the adult problem of overuse of OTC painkillers, which can lead to rebound headaches as well as various gastrointestinal ills. Now, a study presented at last month's American Headache Society scientific meeting in Vancouver, British Columbia, confirms what many physicians who care for children have long suspected: It's a kid problem, too.

"I can't tell you how many times I have a family in my office, and the parents say, 'oh that's where all the ibuprofens are going!' " said Paul Graham Fisher, MD, associate professor in neurology at Stanford University. "Kids think it's OK to take eight, 10 or 15 a day. It's over-the-counter so what could be wrong with it?"

According to the study, 22% of children ages 6 to 18 with recurrent headaches presenting to a specialized clinic were taking more than three doses of OTC medications a week and had been doing so for at least a month and a half. The practice was more prevalent among older children than younger ones, and among girls with chronic tension headaches or a mix of migraine and tension headaches.

"I've been astounded by the large number of kids using over-the-counter medications five or six times a week -- sometimes 15 or 20 times a week," said A. David Rothner, MD, lead author of the study and director of the Pediatric/Adolescent Headache Clinic at the Cleveland Clinic. "A few of them even went into kidney failure or developed gastrointestinal bleeding because of all the medicine they were taking."

Periodic popping is fine

Physicians who care for children say occasional use of OTC pain killers is probably the best thing for the periodic headache, but children and teens can get into trouble if they are too cavalier about their use.

"Judicious use of over-the-counter medication is perfectly fine," said Leon Epstein, MD, head of neurology at Children's Memorial Hospital in Chicago. "It's just that people need education on how to use them."

While most experts feel that dealing with adult overuse is a fairly straightforward matter of patient education, they say that tackling the issue in children and teenagers may be more complicated. Younger children may be mimicking their parents' behavior, and adolescents may be exercising their independence and less willing to listen to a parent, a physician or any other adult.

"How to prevent it is a lot harder because, how much educational material can you get out there that kids are going to read?" said Dr. Bernstein.

This age group also often has a psychosocial cause for their pain that may not be readily apparent.

"Kids have pain in their limbs, their belly and their head when they're stressed out about something," said Andy Spooner, MD, associate professor of pediatrics at the University of Tennessee Health Science Center in Memphis. "Migraine headaches are common in children and sometimes that's all it is, but, in general, your first obligation is to figure out what the psychological factors are in a child having that much pain."

Physicians also complain that although overuse of OTC medication is a serious problem, other options for children and teenagers with recurrent headaches are few. Research into headaches in children is a small field and there are no medications that have received specific Food and Drug Administration approval for this age group. Physicians use treatments off-label that have been approved for adults.

"Nobody pays attention in the academic world to headaches in kids and parents too frequently ignore them," said Dr. Rothner. "We need to do more to study this problem to see how big it is and be able to do something about it."