That Hateful Ache
There are three over-the-counter drugs you can take if you suffer from occasional tension headaches; acetaminophen (Tylenol and other brands), ibuprofen (Advil, Motrin, and others), and aspirin. But how do you decide among the three? Is one more effective than the others?
According to a pooled analysis of multiple studies published in the Annals of Medicine in May this year, although those three over-the-counter medications are effective in treating occasional tension headaches, but ibuprofen is considered more effective and safer than acetaminophen and aspirin, Aspirin and acetaminophen seem to work the same for tension-type headaches, while ibuprofen appears to be superior to both.
In a study comparing 200 mg of ibuprofen to 500 mg of aspirin, ibuprofen was more effective in decreasing headache intensity one hour after treatment. (It’s worth noting that this study was funded by the pharmaceutical company Bayer, the maker of aspirin.) In a different study comparing ibuprofen with acetaminophen, people who took 400 mg of ibuprofen had better and faster pain relief than those who took 1,000 mg of acetaminophen.
That said, you should also consider the symptoms of your headache when deciding which medication to take. For instance, those with neck pain or tension may do better with ibuprofen because it has anti-inflammatory effects that may help to relieve some of it. But if you’re unable to take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin, consider acetaminophen instead. In addition to treating episodic tension-type headaches, acetaminophen can also be used as a pain relief medication for headaches due to viral infections..
Consider Potential Safety Concerns
With acetaminophen, taking too much can damage the liver, so it’s important to take the minimum effective dosage. It’s safest to limit it to 3,000 mg and never exceed 4,000 mg in a day. Don’t take acetaminophen if you drink three or more alcoholic drinks per day. That’s because doing so can severely damage your liver. People with a history of gastrointestinal symptoms should be cautious when taking NSAIDs. These medications might cause stomach discomfort, such as nausea and indigestion.
With ibuprofen, you should know that long-term use at high dosages (more than 2,400 mg per day) may cause an increased risk of cardiovascular events. That’s why people who have recently had a heart attack are advised to avoid ibuprofen.
As for aspirin, you shouldn’t give it to infants or children because of the risk of Reye’s syndrome, a rare but serious illness that causes brain swelling and liver damage. Instead, consider children’s acetaminophen.
If you’re 65 or older, avoid taking aspirin as a pain reliever. Even at low doses, if taken over time, there’s an increased risk of serious side effects. A 2023 study found that taking low dosages of aspirin (about 75 to 100 mg, although the study looked at 100 mg) on a daily long-term basis might increase the overall risk of intracranial bleeding (bleeding within the skull) for older people prone to falls and head trauma.
Finally, don’t take any of these medications for more than 10 days in a row. Doing so can increase the risk of side effects. If your pain persists past this point, it’s time to see your healthcare provider and consider other treatments.
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