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Which is better for headaches – Acetaminophen or Ibuprofen?

Pain relievers such as acetaminophen or ibuprofen are used to help treat headaches – which drug is better for headaches?

Headaches are a common medical problem, usually consisting of pain in the head or upper neck. Headaches are classified as primary or secondary.

This classification is determined based on the characteristics of the headache. Headaches can be treated with over-the-counter medications such as acetaminophen or ibuprofen, but which is better for treating headaches?

Secondary headaches are usually linked with underlying medical conditions such as head or neck injury, vascular disease, infection, and substance (drugs) withdrawal.  

Primary headaches, however, are not linked to any underlying medical conditions. Over ninety percent of the population experience a primary headache at some point during their lifetime.

Common types of primary headaches are tension-type headaches, migraine, and cluster headaches. Tension-type headaches are generally less severe and more common than migraines.

How do acetaminophen and ibuprofen treat headaches?

Headaches can generally be treated using over-the-counter pain relievers, depending on the severity, frequency, or underlying cause of the headaches.

It is recommended that you speak with your doctor or a pharmacist about the products or services available to treat headaches and to find out which treatment for headaches (such as acetaminophen or ibuprofen) might be better for you.

Types of pain relievers commonly used to treat tension-type headaches include analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs).

Migraines with mild symptoms are initially treated with analgesics or NSAIDs. Triptans alone or in combination with NSAIDs may also be prescribed if the initial treatment is not effective.

Acetaminophen (often referred to by the brand name Tylenol) is considered one of the most widely used analgesics. Commonly used nonsteroidal anti-inflammatory drugs are ibuprofen (known by the brand name Advil) or naproxen (known by the brand name Aleve).

Acetaminophen and ibuprofen can both be used to treat pain and fever. Ibuprofen is also generally used to treat inflammation. Both drugs work by inhibiting the COX enzyme, which is responsible for the production of prostaglandins. Taking these medications blocks the production of prostaglandins. Prostaglandins are hormones that are present at sites of inflammation, usually as a response to injury or infection.

Several studies suggest that acetaminophen is as effective as ibuprofen in treating fever. However, it is found to be less effective in reducing inflammation when compared to ibuprofen.

According to research, acetaminophen blocks the production of prostaglandins in the central nervous system and not in other tissues.

While both drugs are used to treat headaches or pain associated with cold or flu infections, ibuprofen is generally chosen to treat muscle strains or sprains, joint aches, or menstrual cramps.

Taking acetaminophen or ibuprofen

Acetaminophen and ibuprofen can be found over the counter at pharmacies or as prescription drugs. In some instances, the choice of drug and dosage may be determined by a physician based on the medical condition being treated, age, or other physical characteristics.

Both drugs can be taken orally or can be given intravenously (IV), however, acetaminophen can also be given rectally. Oral dosage is generally provided in the form of tablets, capsules, or liquid solutions. Acetaminophen tablets come in sizes of 325 mg or 500 mg. Ibuprofen tablets are found in sizes ranging between 200 mg and 800 mg.

It is recommended to take ibuprofen with either food or milk to lower the risk of an upset stomach.

Side effects and drug interactions

Common side effects of taking acetaminophen may include skin rash, nausea, constipation, vomiting, abdominal pain, or anemia. Rare side effects of acetaminophen may include a serious allergic reaction to the drug or severe skin reactions.

People experiencing these side effects should immediately contact their doctor or get emergency help.

Those taking acetaminophen at high doses (beyond the maximum recommended dosage) are at risk of developing liver failure.

According to a study, published in the Journal of Hepatology, Acetaminophen has caused around 500 deaths, 50,000 visits to the emergency room and 10,000 hospital admittances in the United States in a given year.

The medication is considered to be the most common cause of liver failure, related to drug use. This is because after taking this medication orally, acetaminophen is metabolized by the liver.

In the liver, between 60 and 90 percent of this medication is metabolized by glucuronic acid and sulphate conjugate compounds. A small fraction is metabolized by the CY450 enzyme, producing a toxic compound called NAPQI. Acetaminophen overdose leads to the oversaturation of the glucuronic acid and sulphate conjugate metabolic pathways. This leads to elevated levels of  NAPQ1.

Ibuprofen may cause major side effects affecting the gastrointestinal tract, cardiovascular system, and the kidneys.

People with disorders affecting their cardiovascular system, gastrointestinal tract, or kidneys should consult their physician before deciding to take ibuprofen. People taking warfarin (blood thinner), diuretics (water pills), lithium, or blood pressure medications, such as beta blockers and antihypertensives, should not be using ibuprofen because of serious adverse reactions.

Ibuprofen may cause gastrointestinal bleeding, ulcers and impaired renal function. This is because prostaglandins and thromboxane help to maintain the gastrointestinal wall and regulate blood flow in the gastrointestinal tract and kidneys. Thromboxane also plays an important role in forming blood clots.

At high doses, ibuprofen can potentially increase the risk of heart attacks and kidney or renal failure.

According to some studies, ibuprofen may be linked to an elevated risk of high blood pressure in comparison to acetaminophen. The elderly and persons at risk of high blood pressure using ibuprofen should be monitored by their healthcare providers.

The choice to take acetaminophen or ibuprofen for headaches may depend on other medical conditions or medications that are also being taken. Always consult your healthcare provider before taking any medications or supplements.



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