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Over-the-Counter Treatments for Headaches

By Rosalyn Carson-DeWitt, MD

Updated February 12, 2009

(LifeWire) - Although some headaches may require the firepower of a prescription drug, others respond to basic over-the-counter (OTC) pain medications, which have the advantage of being readily available and relatively inexpensive. Their use -- plus the use of other interventions, depending on the type of headache you have -- may help ease your pain.

Types of Headaches

  • Tension-type headaches
    These are headaches that occur due to muscle spasm, causing a tight band of pain around the head. They last hours to days, don't worsen with activity and tend to be nagging rather than disabling.


  • Migraine headaches
    These disabling headaches usually cause significant pulsing pain in one area of the head or behind one eye. Common accompanying symptoms include sensitivity to light, nausea and vomiting. Symptoms typically worsen with activity. These headaches can last hours or days, often completely interrupting the individual's normal functioning.


  • Sinus headaches
    Pressure and pain behind the sinuses (hollow spaces within the skull, located behind your cheeks, brow, and forehead) can lead to chronic, nagging headaches. Often associated with nasal congestion, sinus headaches may occur due to allergies or sinus infections.


  • Cluster headaches
    These headaches come on quickly, usually affect just one side of the head and rapidly reach severe intensity. Tearing or congestion may occur on the same side as the pain. Cluster headaches may last for minutes or hours and may recur several times a day for months.

Regardless of the type you have, if your pain is mild to moderate, one of the two main classes of OTC headache remedies -- acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) -- is a good place to start.

Acetaminophen and NSAIDs

Acetaminophen, such as Tylenol, is an analgesic medication, and its main function is to increase your brain's threshold of pain. Be sure to consider the following precautions when using acetaminophen:

  • Don't exceed the recommended dose.


  • Don't combine acetaminophen with other acetaminophen-containing medications, such as certain OTC sleep aids; allergy, flu and sinus medications; or prescription medications, such as hydrocodone, oxycodone or codeine, which may be formulated with acetaminophen.


  • Don't drink alcohol while using acetaminophen; the combination can do harm to your liver.


  • If you have known kidney or liver disease, check with your doctor before using acetaminophen.

    When properly used, acetaminophen has few side effects, although overdoses can lead to irreversible liver damage.

    NSAIDs include aspirin (acetylsalicylic acid) as well as Motrin or Advil (ibuprofen , Actron (ketoprofen), Aleve or Naprosyn (naproxen) and others. NSAIDs work by interrupting the production of certain pain-inducing chemicals called prostaglandins. Be sure to consider the following precautions when using NSAIDs:

    • Check with your doctor before using NSAIDs if you have an ulcer, if you're using blood-thinning medications -- such as Coumadin (warfarin) -- or if you have gastroesophageal reflux, liver or kidney disease.


    • Avoid NSAIDs if you've recently had or are about to undergo any kind of surgery, including dental surgery.


    • Be aware that aspirin can worsen symptoms of asthma in some people (especially people who have nasal polyps).


    • Never give aspirin to children or teenagers -- especially if they have the flu or chickenpox -- because it increases their risk of developing the life-threatening condition known as Reye's syndrome.

      Possible side effects of NSAIDs include ringing in the ears (tinnitus), worsening of asthma, stomach irritation and bleeding. Allergic reactions to aspirin can result in redness, swelling, hives and difficulty breathing.

      There are also preparations on the market that combine acetaminophen, aspirin or other NSAIDs with one another, with caffeine or both. (Caffeine serves to improve the body's absorption of headache medicines and to enhance their effectiveness.)

      Don't Overdo It

      OTC pain medicines are often an important and effective treatment for migraine, tension and sinus headaches, but they can be double-edged swords. In fact, using these drugs more than twice a week or so (especially those that contain caffeine) can actually cause headaches.

      This phenomenon, known as a "rebound" or medication-overuse headache, can be difficult to shake; there's a tendency is to become locked into a vicious cycle of rebound pain, followed by more OTC medication use, followed by more rebound pain.

      Remember that even though OTC remedies are available without a prescription, they're still powerful medications and should be taken with care.

      What Else Can I Do to Ease My Pain?

      If you tend to have sinus headaches, you may want to add a decongestant (either an oral drug or a nasal spray) to see if that helps. Aside from OTC medications, though, you can try other techniques to ease your headache. For migraines, rest in a darkened room with your eyes closed. For tension headaches, take a hot shower, or use an icepack on the back of your neck to relax tight muscles. A saline nose spray can help reduce the congestion associated with sinus headaches.

      Keeping a headache journal can help you monitor the details of your headaches, including what seems to trigger them, their frequency and severity, and how they respond to various treatments. The journal can also help you determine which drugs work best and avoid taking medications too frequently.

      What If I Try OTC Medications and They Don't Work for Me?

      If you don't get pain relief from OTC medications, you have to use such products more than twice a week, or you frequently endure vomiting or other symptoms during a headache attack, check with your healthcare provider to see if trying a prescription medication might help prevent the headaches before they start.

      Sources:

      Dooley, J.M. "Caffeine as an Adjuvant to Ibuprofen in Treating Childhood Headaches." Pediatric Neurology. 37:1(2007):42-46. 25 Apr. 2008 <http://linkinghub.elsevier.com/retrieve/pii/S0887899407001221> (subscription).



      Goldstein, J. et al. "Acetaminophen, Aspirin, and Caffeine Versus Sumatriptan Succinate in the Early Treatment of Migraine: Results from the ASSET Trial." Headache 45:8(2006):973-982. 25 Apr. 2008 <http://www3.interscience.wiley.com/journal/118644411/abstract> (subscription).



      McConaghy, J.R. "Headache in Primary Care." Primary Care. 34:1(2007):83-97. 25 Apr. 2008

      <http://www.mdconsult.com/das/article/body/103545188-5/jorg=journal&source=MI&sp=19495158&sid=742067759/N/581668/1.html?issn=0095-4543> (subscription).



      Silberstein, S.D., and W.B. Young. "Headache and Facial Pain." Textbook of Clinical Neurology, 3rd ed. Christopher C. Goetz. Philadelphia: Saunders, 2007:1245-62. 25 Apr. 2008



      Wenzel, R.G., C.A. Sarvis, and M.L. Krause. "Over-the-Counter-Drugs for Acute Migraine Attacks: Literature Review and Recommendations." Pharmacotherapy 23:4(2003): 494-505. 25 Apr. 2008 <http://www.atypon-link.com/PPI/doi/abs/10.1592/phco.23.4.494.32124> (subscription).


      LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Rosalyn Carson-DeWitt, MD, works as a medical writer, editor, and consultant in Durham, NC. She served as editor-in-chief for two multi-volume MacMillan encyclopedias: The Encyclopedia of Drugs, Alcohol, and Addictive Behavior and Drugs, Alcohol and Tobacco: Learning About Addictive Behavior. She worked on the 18th edition of the Merck Manual of Diagnosis and Therapy, and has written thousands of print and online articles for healthcare providers and consumers.
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