New guidance from the National Institute for Health and Clinical Excellence is advising healthcare professionals to examine the possibility of “medication overuse” in patients presenting with headaches.

According to the Institute, around one in 50 patients in the UK - which equates to around one million people - is experiencing headaches caused by taking painkillers or triptan-based drugs too frequently for tension-type headaches or migraines.

The warning concerns those patients who take medicines for 10-15 days every month over three months, because this can not only reduce the effectiveness of treatment but also cause further pain.

“Patients with frequent tension-type headaches or migraines can get themselves into a vicious cycle, where their headaches are getting increasingly worse, so they take more medication which makes their pain even worse as they take more medication," explained GP Martin Underwood, professor of primary care research at Warwick Medical School and chair of the guideline’s development.

It is hoped NICE's guideline will help to improve awareness of medication overuse headache both in primary care and among the general public, "because prevention is simple and treatment is difficult", it stressed.

Also, "by clearly outlining the common features associated with primary headaches, the guideline will improve recognition and empower healthcare professionals to manage headaches more effectively, with better targeting of treatments", noted Manjit Matharu, an honorary consultant neurologist at the National Hospital for Neurology and Neurosurgery and guideline developer.

Headaches are one of the most common healthcare complaints in the UK, with more than 10 million people regularly suffering from them, and they account for around one in 25 GP consultations.

Neutropenic sepsis guidance

Meanwhile, the Institute has also published a new guideline that it hopes will address current shortcomings in the prevention and management of neutropenic sepsis, a growing and potentially fatal complication of cancer treatment.

Many cancer therapies carry the risk of suppressing the production of white blood cells known as neutrophils, compromising the body’s capacity to fight infection. When 'neutropenic', patients are at risk from rapid onset invasive infection, or sepsis, which is potentially fatal. 

Unfortunately, not only is neutropenic sepsis relatively common - resulting in hundreds of hospital admissions every month and 1 in 500 cancer patient fatalities - but its incidence is on the rise, highlighting the urgent need for prevention and management strategies.

According to the Institute, estimates claim the total number of deaths from neutropenic sepsis in England and Wales has more than doubled over the last 10 years from around 300 in 2001 to around 700 in 2011. 

"This guideline aims to reduce the number of avoidable deaths and improve outcomes for patients presenting with this important complication of anti-cancer treatments by clearly defining the clinical signs and symptoms of neutropenic sepsis that should prompt a timely diagnosis," said Professor Mark Baker, Director of the Centre for Clinical Practice at NICE.

"It also defines a clear pathway for the effective management and treatment of cancer patients presenting with the condition, as well as highlighting the most effective strategies for its prevention,” he noted.

In addition, "recommendations for prophylaxis to prevent neutropenic sepsis, and guidance on when treatment can be offered as an outpatient rather than an inpatient, may help to reduce the length of hospital stays or negate the need for admission at all, thus affording many patients more time at home," added Rachel Drew, patient and carer member on the guideline development group.