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HeadWay Issue #217 - Over-the-counter Painkillers - A Better Option?
November 21, 2022
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In this issue:

Over-the-counter "Painkillers": A Better Option?

Recently @ Headache and Migraine News

Say what?! Medication-Overuse Headache


Over-the-counter "Painkillers": A Better Option?

Many of us have a love-hate relationship with over-the-counter "painkillers". Of course there's the fear of being "brushed off" by a doctor and being told to "take two and call me in the morning". Then there are the times when they don't work. Or the times when we're afraid we're taking too many, leading to medication-overuse headaches.

Today, as further information becomes available, there are increased concerns about some of the typical medications, such as ibuprofen, aspirin (acetylsalicylic acid), and paracetamol (acetaminophen). Earlier this month I wrote about why paracetamol doesn't seem to be as popular as it used to be for headache treatment (see Falling from Favour: Paracetamol / Acetaminophen). A few years ago we talked about ibuprofen - Ibuprofen: Dangers of a “mild” medication...

Although I'm not ready to throw away these three popular drugs, there is reason to re-evaluate our use of them.

In fact, in some ways I've gained a greater respect for them - especially aspirin and ibuprofen. But we're still learning about all three - and there is reason to use them with care.

After 18 years of study and experience, here are some quick recommendations for you:
  1. Never exceed the recommended dosage on the label. Let's start with that. More is not necessarily better. Taking too much at a time, or over time, can cause long term problems.
  2. If you're getting a headache every week, or even every month, see a specialist if at all possible. Because of your history, or family history, or what your friends tell you, you might think that this is "normal" and you just have to "live with it". Don't believe it. Regular headaches are taking hours and days from your life and productivity, and there may be some treatments that will give you that time.
  3. Don't assume that aspirin, paracetamol, or ibuprofen will never work. After giving up on these, some people find that the right one at the right dosage actually can be a big help, if used occasionally. This article covers just NSAIDs, but one of these may be your best option for migraine.
  4. Consider other treatments, including supplements and preventative medications. Many people are nervous about taking something "every day for the rest of my life". But first, things change - don't assume it will be that long! Second, a good treatment daily may be much better in the long term than popping a "painkiller" too often. With the right treatment, you may experience fewer attacks - and less chance that they'll get worse in the long run.
  5. Lifestyle! That's the other thing everyone is afraid of. What?! Change what I eat? Exercise?? Listen, even if you have a treatment that's lessening your headaches, keep on making small, long-term changes in your lifestyle. A little movement, a little less sugar - whatever it is for you. Your future self will thank you.
  6. If you're taking an over-the-counter medication more than "rarely" - it's time to see the specialist. It's easy for all of us to find that every couple of months becomes twice a week. Take the time to care for yourself - keep looking for better options.
Yes, with all our new headache and migraine medications, we may forget that the more common drugs can still be useful, if used properly. For some of us, at some stages, they may be a big help.


Recently @ Headache and Migraine News

A few recent articles you may have missed:

Say what?! Medication-Overuse Headache

Although many doctors speak with great confidence about medication-overuse headache (MOH), it's actually quite a controversial topic. How common is it? Which medications cause it?

The controversy is far from over. However, the basic idea is that taking too much medication may cause more headaches - even making them worse - and chronic.

The International Classification of Headache Disorders 3 database lists several possibilities - from paracetamol to triptans to aspirin to NSAIDs such as ibuprofen. There may also be problems from combinations of treatments.

While recognizing the still controversial nature of MOH, you can read some of the common thinking by clicking through the ICHD-3 index on this page.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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