Headache Relief

MARCH 01, 2009
Yvette C. Terrie, BSPharm, RPh

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

Headaches can range from mild to severe and are considered to be one of the most common health complaints in the United States. An estimated 45 million individuals experience chronic headaches each year that cost billions of dollars in lost productivity.1 Although the majority of headaches are mild and last only a few hours, some individuals may experience headaches that persist for weeks.

Types of Headaches

In general, headaches are categorized as primary or secondary. Primary headaches account for approximately 90% of headaches and are not related to an underlying illness.2 Examples of primary headaches include tension headache, cluster headache, migraine, and medication overuse headaches (also known as rebound headaches).1-4

A headache is classified as a secondary headache when it is the result of another underlying medical condition. Examples include sinusitis, severe hypertension, head trauma, hematomas, temporomandibular joint dysfunction, metabolic disorders, cerebral hemorrhage, and meningitis.5-7

Patients experiencing secondary headaches, as well as those with chronic headaches and/or severe headaches, should always be referred for further medical evaluation and treatment. Examples of when to seek further medical evaluation include individuals with severe head pain or head trauma, headaches that persist >10 days with or without treatment, and individuals with high fever or signs of infection.2

Characteristics of Primary Headaches

Tension Headaches
Tension headaches, also known as muscle contraction headaches, affect an estimated 75% of US adults and are considered to be more prevalent in women.2,5 They are characterized by mild pain that gradually initiates in the area in the back of the head and upper neck. The pain is usually bilateral and often described as tight, pressing, and constricting.1,2,8 Tension headaches may last from minutes to days.1-3 Stress, anxiety, fatigue, eye strain, and muscular tension are common causes of these headaches.2

Migraine Headaches
Migraine headaches, which affect an estimated 20% to 25% of individuals including children, are considered to be the second most common type of primary headache.2 Migraine sufferers usually have their first attack before age 30, but migraines also can occur in children as young as age 3.1 As with tension headaches, women experience a greater incidence of migraines when compared with men, affecting an estimated 18% of women and 6% of men.2,5,9 Many women have premenstrual migraine attacks; however, they can occur at any time during the menstrual cycle.2 The incidence of migraine headaches is equal among boys and girls before puberty, and incidence typically disappears in boys after puberty.2,5

The pain associated with migraine headaches often is unilateral and can be described as intense and throbbing.1,2,8 The pain may be preceded by an aura, and onset may be sudden. Some individuals may experience sensitivity to light, noise, or odors, as well as nausea and vomiting.1,2,8 Migraine headaches may last from hours to days.1,2,8 Factors that may precipitate a migraine headache include stress, anxiety, changes in weather, altitude, and/or air pressure, hormonal changes, use of certain pharmacologic agents (eg, nitrates, oral contraceptives, nifedipine, estrogen replacement therapy), changes in sleep or eating patterns, environmental factors, food insensitivities, and alcohol consumption.2,8

Cluster Headaches
Cluster headaches are the least occurring of the primary headaches affecting 1% of the population.5,8 Cluster headaches are more prevalent among men, accounting for 85% to 90% of individuals experiencing cluster headaches.3,5 Cluster headaches are often accompanied by pain that is throbbing and constant and typically is unilateral, occurring around or behind one eye. The affected eye may become red, inflamed, and watery.1,2,8 These headaches may last 30 to 90 minutes. Cluster headaches can occur daily in clusters of weeks or months. Individuals suspected of having cluster headaches should be encouraged to see their primary health care provider.3,5


Counseling Tips for Using OTC Analgesics

  • Patients should be advised not to use OTC analgesics for >10 days unless directed by a physician and to not exceed the recommended dosages.
  • The use of OTC analgesics for treatment of headache should be restricted to 3 days per week to avoid the potential for medication overuse headaches.
  • Naproxen should not be used in children <12 years of age.
  • Patients who have allergies to ASA, asthma, or nasal polyps should not take ASAs or NSAIDs.
  • Patients who are pregnant, breast-feeding, or have a preexisting medical condition should be encouraged to consult their primary health care provider prior to using any of these products.
  • Patients currently taking medications for diabetes, gout, or arthritis should not use an ASA, unless directed by their primary health care provider.
  • Individuals with a history of hepatic disease should avoid the use of APAPs.
  • Do not administer ASAs or other salicylates to children <15 years of age who are recovering from chickenpox or symptoms of influenza.
  • Patients on anticoagulation therapy should be advised to consult their primary health care provider.

APAP = N-acetyl-para-aminophenol (acetaminophen); ASA = acetylated salicylate; NSAID = nonsteroidal anti-inflammatory drug.
Adapted from reference 2.

OTC Therapies

The types of headaches that are most often amenable to self-treatment with the use of OTC analgesics include tension headaches, diagnosed migraines (vascular), and sinus headaches.2 Pharmacists are an important source of information for patients on the use and selection of these products (Table). These products include acetaminophen, acetylated salicylate, nonacetylated salicylates (choline salicylate, magnesium salicylate, and sodium salicylate), and nonsteroidal anti-inflammatory agents.

The Role of the Pharmacist

Prior to recommending any of these agents, pharmacists should screen for possible allergies and drug interactions, as well as possible contraindications (eg, individuals with renal and hepatic insufficiencies, history of gastric ulcers, or those currently taking anticoagulants) and refer patients to seek further medical evaluation when warranted. Patients with a history of headaches should be encouraged to seek medical care to identify potential precipitating factors. Patients also should be reminded about rebound headaches that may occur as a result of excessive medication use and to not exceed recommended dosages.

Pharmacists also can recommend various nonpharmacologic measures that may alleviate or decrease the occurrence of headaches, such as relaxation techniques, avoiding stress, getting an adequate amount of sleep, and eating a balanced diet. It is important to remind patients to contact their primary health care provider if headaches increase in intensity and/or frequency.


Examples of OTC Analgesics for Headaches

Active Ingredient

Brand Name


Tylenol (Regular and Extra Strength)
Tylenol 8 Hour


Bayer Rapid Headache Relief
Bufferin (Regular and Extra Strength)


Advil Migraine

Naproxen sodium


Adapted from reference 2.


Examples of Combination OTC Headache Products

Active Ingredient

Brand Name

Acetaminophen, phenylephrine

Excedrin Sinus Headache
Sudafed PE Maximum Strength
Sinus Headache

Naproxen sodium and pseudoephedrine

Aleve Sinus and Headache

Acetaminophen, aspirin, caffeine

Anacin Advanced Headache Formula
Excedrin Migraine
Excedrin Extra Strength
Goody's Extra Strength Headache Powder
Vanquish Extra Strength

Aluminum hydroxide, aspirin calcium carbonate, magnesium hydroxide

Ascriptin Maximum Strength

Acetaminophen and caffeine

Excedrin Tension Headache


Examples of Topical OTC Headache Products

  • WellPatch Migraine Cooling Headache Pads
  • HeadOn Topical Treatments for Headache (available formulations include Tension, Extra Strength, Migraine, Sinus)
  • Sinol Headache Relief Spray, Migraine Cluster Tension

For more information on headaches, please visit the following Web sites:


  1. Headaches. American College of Physicians Web site. www.acponline.org/patients_families/diseases_conditions/headaches. Accessed December 30, 2008.
  2. Remington, T. Headache. In: Berardi R, Newton G, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:69-89.
  3. Headache Types. Excedrin Web site. www.excedrin.com/headache-types.shtml. Accessed December 30, 2008.
  4. Tension Type Headaches. Bayer HealthCare Web site. www.aspirin.com/aoi/hfh/tension_type_en.html. Accessed December 30, 2008.
  5. Headache. MedicineNet Web site. www.medicinenet.com/script/main/art.asp?articlekey=20628&pf=3&page=1. Accessed December 29, 2008.
  6. Secondary Headaches. American Headache Society Web site. www.achenet.org/education/patients/SecondaryHeadaches.asp. Accessed December 29, 2008.
  7. Headaches. Merck Manual Web site. www.merck.com/mmpe/sec16/ch216/ch216a.html#CACCDJAH. Accessed December 29, 2008.
  8. Causes of Headaches. Excedrin Web site. www.excedrin.com/headache-causes.shtml. Accessed December 30, 2008.
  9. Headache Information. National Institute of Neurological Disorders and Stroke Web site. www.ninds.nih.gov/disorders/headache/headache.htm. Accessed December 30, 2008.