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Clinician’s Corner: Use of General analgesics for management of acute headaches (tension or migraine)

For mild to moderate migraine attacks not associated with vomiting or severe nausea, simple analgesics like  non-steroidal anti-inflammatory drugs (NSAIDs) , acetaminophen or combination analgesics are first choice agents because they are effective, less expensive, and less likely to cause adverse effects than some of the prescription migraine drugs

Acetaminophen:

Adverse effects:

Acetaminophen dose:

  • max: 4000mg /day in healthy patient,
  • max: 3000mg if drinking alcohol (social)
  • max: 2000mg if an alcoholic- best to limit acetaminophen use

Drug interactions:

Acetaminophen overdose is the most common cause of acute liver failure in the U.S. Around 30,000 patients are hospitalized each year in the U.S. to undergo treatment for this condition.

Acetaminophen: warfarin- If acetaminophen is necessary at doses near or greater than 2 g/day for more than 1 day, extra blood monitoring should be considered.

NONSTEROIDIAL ANTI-INFLAMMATORIES

Mechanism: NSAIDS inhibit cyclooxygenase (COX-1 & COX-2) which are enzymes that catalyzes the synthesis of prostaglandins, which are hormone-like substances that involve inflammation, blood pressure control and kidney function.

  • Blocking COX-1 : causes blood thinning (good) and stomach ulcers (bad)
  • Blocking COX-2: causes coagulation (bad) and protects stomach (good)

OTC NSAIDS

Aspirin:  325mg tablets, 165mg & 81mg tablets (Ecotrin max strength 500mg & 650mg)

  • Dosage: 1 or 2 tablets every 4 hours as needed for pain
  • Monitor for increased bleeding with warfarin and aspirin. May cause stomach bleeds and ringing in the ears.

Ibuprofen (Advil®, Motrin®) 200mg tablets OTC       400,600,800mg RX

  • Dosage 200-400mg every 4-6 hours
  • OTC maximum is 1200mg; Rx maximum is 3200mg

Naproxen sodium (Aleve®) 220mg OTC           Anaprox® 275 &550mg RX

  • OTC Dosage: 220 every 8-12 hours. OTC maximum=440-660mg
  • Rx maximum dose: Anaprox® 1100-1650)
  • Rx maximum dose: 1000-1500mg (Naproxen-Naprosyn®)

Side effects for NSAIDS: GI toxicity, bleeding, ulceration,

Avoid NSAIDs because:

  • May decrease kidney function
  • Avoid if pregnant
  • active stomach disease
  • Caution in liver impairment.
  • Increase sun burning
  • Avoid Aspirin & alcohol while taking NSAID
  • Watch for high blood pressure
  • Avoid if heart failure
  • Increased risk of heart attack, stroke, CV death

Patient information:

  • Know signs and symptoms of GI bleeding,
  • Photosensitivity- use a good sunscreen-frequently apply.
  • Avoid Aspirin & alcohol while taking NSAID

DRUG interactions:

  • All OTC medications should be used with caution with blood thinners
  • Do not take with other NSAIDS

Patient information for NSAIDS

  • Take with food to avoid GI upset
  • Asthmatics –caution with aspirin
  • Do not take OTC NSAIDS with prescription NSAIDS

Numerous combinations of OTC meds with aspirin & acetaminophen:

  • Percogesic (acetaminophen + diphenhydramine)
    • Acetaminophen 325 mg/diphenhydramine 12.5 mg: 2 tablets orally every 4 to 6 hours as
    • Acetaminophen 500 mg/diphenhydramine 12.5 mg: 2 tablets every 6 hours
  • Excedrin (aspirin 250mg + acetaminophen 250mg + caffeine 65mg) 2 caplets as a single dose
  • Bufferin (aspirin 325mg + calcium carb+ mag carb + mag oxide) 2 tablets every 4 hours (maximum of 12 per day)
  • Vanquish (acetaminophen 194mg + aspirin 227mg + caffeine 33mg) max=8 caplets/day

Other techniques to recover from headaches:

  • Lie down and relax.
  • Use warm/cold compresses (your choice).
  • Warm bath or massage.
  • LIMIT number of pillows!

A headache specialist says this about NSAIDs:

  • Relatively unlikely to cause drug induced headache.
  • Safe in the presence of blood vessel disease
  • No drowsiness
  • No Increase in Nausea, if having a migraine
  • Efficacy for mild to moderated headache
  • High doses are to be used.
  • Migraine is an inflammatory disorder.

Can you imagine a world without over the counter ibuprofen and naproxen sodium? Up until May 18, 1984, ibuprofen was prescription only. It was not until ten years later in January 1994, did naproxen come over the counter.

Your Thompson Pharmacist can recommend over the counter therapies to help you get inexpensive, quick, and immediate relief for their headaches.  Always consult your Thompson Pharmacist especially if you have heart disease, high blood pressure, stomach disease or kidney disease.

Go Ahead and ASK…at Thompson Pharmacy it’s ALL for YOU!!