in the spotlight

Treating frequent headaches with pain relievers


When you need them—and when you don’t

Many people suffer from frequent, severe headaches, including migraines. These headaches need careful treatment, with a focus on prevention. Talk to your doctor about
ways to prevent and treat your headaches.

  • Limit use of over-the-counter pain drugs. If you are taking them more than two days a week, cut back.
  • Avoid using prescription drugs containing opioids or butalbital, except as a last resort.

It is easy to use too much pain medicine. This can make headaches worse and cause other medical problems. Here’s why:
Over-the-counter pain medicines can have dangerous side effects.
Aspirin, acetaminophen, and ibuprofen work well for headaches if you don’t use them often. But if you take these drugs too often, you can get serious side effects. In rare cases, if you often take acetaminophen several days in a row, you can
damage your liver. This can happen even if you take just a little over the recommended dose.
Rarely, these drugs can also cause kidney problems. Aspirin and ibuprofen can, at times, cause stomach bleeding.
Watch out for overuse headaches.
If you overuse pain medicines, they may no longer help as much. And you may also get headaches more often. This worsening of headaches is called “medication overuse headaches.” The following drugs are thought to most likely cause overuse headaches. They may also make you more sensitive to pain:
Prescription drugs:

  • Drugs with butalbital (Fiorinal, Fioricet, Esgic and others)
  • Opioid painkillers
    • hydrocodone (Vicodin and other brands and generics)
    • oxycodone (OxyContin, Percodan, Percocet and others)

Non-prescription drugs that contain caffeine (Excedrin Migraine)
Some pain drugs can cause addiction.
Drugs that contain opioids or butalbital can make you drowsy. Long-term use of these drugs can cause addiction or physical dependence, and overuse headaches.
Some people need headache treatment for years, or even decades. They should take addictive drugs only if safer treatments don’t work. If you do have to take addictive drugs, ask your doctor how to avoid overuse and addiction.
Lifestyle changes can help some people with severe headaches.
Often, you can prevent headaches or have them less often if you:

  • Reduce stress, or learn to cope with it more effectively.
  • Drink a minimum of alcohol.
  • Get enough sleep.

If you still get headaches more than once a week, you can consider taking a daily preventive drug.
If you need pain relief during a bad migraine, drugs called triptans work well for most people. They usually have fewer side effects than other prescription drugs. Four of the seven FDA-approved triptans are available as generics, such as sumatriptan (Imitrex).

Tips to help you manage headache pain

Keep a record of each headache. Note possible triggers—foods, beverages, sleep patterns, or other things that cause your headaches.
Reduce triggers. For example, consider using tinted glasses to reduce the effects of bright light. If menstruation routinely leads to migraines, ask your doctor if you could ward off headaches by taking ibuprofen (Advil, Motrin IB, and generic) regularly for a few days around your period.

Simple changes can sometimes prevent headaches:

  • Cut back on alcohol.
  • Control the effects of stress with bio-feed- back, meditation, relaxation, or in other ways.
  • Aim for 6 to 8 hours sleep each night. Go to bed and wake up around the same time. Don’t watch TV or use a computer in bed. If you snore, ask your doctor if you should be checked for sleep apnea.

If you need preventive drugs, start with safer choices. Choose drugs that have been proven to work. Beta blockers are often the best first choice. They don’t cost much and they have long safety records. Examples include propranolol (Inderal and generic) and timolol (Blocadren and generic). Some side effects are fatigue and fainting, caused by low blood pressure.
This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment.
© 2014 Consumer Reports. Developed in cooperation with the American Headache Society.

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