Chronic headaches: what to do when your painkillers no longer help

Written by: Dr Shankar Ramaswamy
Published: | Updated: 09/12/2020
Edited by: Robert Smith

We previously spoke with expert pain medicine specialist, Dr Shankar Ramaswamy, to find out what determines if a headache is chronic and what some of the main triggers are.

woman with chronic headache

In this second part of our discussion with Dr Shankar Ramaswamy we found out how to treat headaches when pain medications such as Ibuprofen no longer help.

Dr Ramaswamy highlights some more effective treatment options, preventative measures that can be followed and information on when might be the ideal time to visit a pain management specialist.

What happens if simple pain medications (such as Ibuprofen) are no longer helping?


Simple pain killers such as ibuprofen, paracetamol or codeine based medications are not designed for treating a long-term condition such as chronic headache as they associated with side effects such as gastric ulcers, kidney failure, so should only be taken for short time, and not too frequently. It is recommended that they are used for less than 15 days a month as otherwise it can result in a condition called medical overuse headache.


Patients should speak to their GP in the first instance and perhaps get referred to a headache specialist such as a neurologist or chronic pain specialists with a special interest in headache. They would aim to make a formal diagnosis for their chronic headache and recommend alternative type of medications designed to manage specific headache disorder such as an anti-migraine medication or medications used for treat other chronic pain conditions such as anti-neuropathic medications.

When should someone visit a pain management specialist about their headaches?

When simple pain medications don’t work or if they’ve taken conventional anti headache meds such as anti-migraine medications and headaches has now become chronic and refractory, they should see a pain specialist. They should also see a pain specialist if they have other comorbidities, such as other pain conditions such as fibromyalgia, cervical spondylitis (degeneration of cervical spine). A pain specialist, apart from helping them to manage their chronic headaches, they will also help to manage the impact of their headache in daily life by using a variety of techniques including medications, self-management advice and special interventions.

So it is advisable for patients with complex headache and other comorbidities see a pain management specialist. They often work along with other members of a multidisciplinary team such as a neurologist, physiotherapist or a psychologist to offer best care to their patients.

What are the treatment options?

Treatment options include the following:

  • Medications: including simple analgesics, specific anti-migraine tablets other medications such as antineurotic medications.
  • Interventions: nerve blockers, facet joint injections, botox injection for migraine.
  • Neuromodulation: including peripheral neuromodulation, occipital nerve stimulation.


Are there any preventative measures that a patient can follow?

We would encourage patients to maintain a headache diary, noting down patterns of headaches, giving information on timing, frequency, severity, triggers or precipitating factors for their headache.

A well-structured headache diary finds way we can avoid headaches, for example, addressing sleep, avoiding certain foods such as cheese and alcohol. Prophylactic or preventive medication is often used to anticipate and prevent a headache attack.

Sometimes we do periodic interventions (e.g. every 2-3 months) such as nerve blocks, Botox injections to anticipate and prevent headache attacks. This will often form part of their bespoke or individualized treatment strategy to help patients manage their long-term condition and help them maintain their quality of life.

To discover how to treat your headaches once and for all, it is recommended to chat with an expert consultant in pain medicine such as Dr Shankar Ramaswamy . Visit his Top Doctors profile today for more information.

Dr Shankar Ramaswamy

By Dr Shankar Ramaswamy
Pain medicine

An important note with regard to the COVID-19 pandemic: We are offering video consultations to all patients at flexible times and at short notice. This is authorised by all insurance providers. Our team also offers physiotherapy via video consultation and we are able to offer interventions quickly for 'low risk' patients at safe premises in London. We will risk-assess all patients prior to this.

Dr Shankar Ramaswamy is a leading consultant in anaesthesia, pain management and neuromodulation based in Central London, Southeast London and Kent. Among the wide range of conditions that he manages are neck and back pain, headache and facial pain, cancer pain, neuropathic pain, musculoskeletal pain including fibromyalgia and joint pain, abdominal and pelvic pain, sports injury and trauma and accident-related pain including whiplash injury.

He is the clinical lead for the busy inpatient pain service at the Royal London Hospital and also the lead for pain management for the Newham MSK Collaboration. He is also the lead for education in pain management for Barts Health and QMUL and a course director and honorary senior lecturer for MSc Pain Management, University of Edinburgh.

His first qualifications and training in the field of anaesthesia were earned in India, including at one of the most prestigious medical and research institutions in India, the PGIMER. Once in the UK, he continued his anaesthetic training and then underwent the Advanced Pain Fellowship at the renowned Imperial Healthcare, London.

Over the duration of his career, he has garnered extensive experience that he uses to provide care of the highest quality to his patients. He commits to providing comprehensive pain management plans that are centred on each patient's individual needs. He uses a variety of techniques including self-management advice, pharmacotherapy, and cutting-edge (X-ray-guided and ultrasound-guided) interventions such as epidural, facet joint injections, peripheral joint injections (e.g. hips, knees, shoulder), radiofrequency, laser disc therapy, regenerative medicine (PRP) and neuromodulation. He is part of a large multi-disciplinary team to facilitate and individualise pain management approach.

Dr Ramaswamy has also received training in medico-legal report writing and is familiar with civil procedure protocols including CPR part 35 and PD 35 protocol. He can provide detailed insights into causality, prognosis, assessing capacity to work understanding specific roles, assess the ability to function and also comment on the prospect of achieving pain relief. He also offers medicolegal appointments at short notice and can produce a report with a quick turn around time. He sees patients for personal injury claims and criminal negligence claims.

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