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Medical Author:

Mark Langdorf, MD

Coauthor:

Aaron Bright, MD

Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Although relatively safe, over-the-counter pain medicines all have potential side effects. Inappropriate use may have serious consequences. Always read the label and follow the recommended dosage.

Even nonprescription pain medicines can be dangerous if taken improperly or if taken for headache that is caused by certain diseases (such as bleeding or stroke). Potential problems include overdose, overuse, cross-reactions with other medications (especially with blood thinners), and toxic effects on various organs (especially the liver).

• Acetaminophen (Tylenol) is a safe and very effective pain reliever and should be considered the first-line treatment of headache.
• Although acetaminophen has few cross-reactions with other medications, avoid taking with alcohol and sleeping medicines (barbiturates and benzodiazepines such as Valium). Unless advised by a doctor, people with liver diseases such as cirrhosis or hepatitis, and heavy drinkers, should avoid acetaminophen.
• If acetaminophen alone is inadequate, some people report the addition of caffeine to the acetaminophen provides more relief from pain (Excedrin) and is a reasonable choice for those people who can tolerate caffeine well.
• Drinking a cup of caffeinated coffee with a pain reliever can provide the same caffeine effect. By increasing the production of stomach acid, caffeine helps the body absorb headache medicines more quickly.
• Acetaminophen is generally safe for pregnant women who have a headache to take. If you have constant or persistent headache with pregnancy, consult your doctor.
• Aspirin is another common pain reliever. Its most common side effects are stomach upset and increased risk of bleeding. Aspirin is a type of "nonsteroidal anti-inflammatory drug."
• People with stomach ulcers or on blood thinners such as warfarin (Coumadin) should not take aspirin.
• Alcohol use increases the risk of bleeding. Heavy drinkers should not take aspirin because of the risk of bleeding from stomach irritation or ulcer formation.
• People older than 60 years and those with kidney problems should not take aspirin unless advised by their doctor.
• Aspirin is commonly prescribed by doctors after a stroke without bleeding and can prevent another stroke.
• Taking aspirin for undiagnosed severe headache may be dangerous. The severe headache could come from a bleeding stroke and taking aspirin may make the bleeding worse.
• Nonsteroidal anti-inflammatory drugs known as NSAIDs include such medications as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve, Naprosyn). These medications are often used for headache.
• The side effects are similar to those of aspirin. It is important not to take aspirin and other NSAIDs together because the side effects are additive -- meaning they build on each other and become worse than one taken alone.
• The same warnings about age, kidney disease, stroke, and alcohol problems apply to other NSAIDs as well as to aspirin.
• Homeopathic, herbal, and other remedies that are not tested for safety or regulated by the Food and Drug Administration (FDA) can be potentially dangerous and are not recommended. Without FDA regulation there is no control over the quality, dose, or ingredients. Scientific studies that document safety and effectiveness are not required prior to the sale of these unregulated products.

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