Headaches are a common health complaint, and selecting the right OTC product depends on the headache's type and intensity.
Ms. Terrie is a clinical pharmacy writerbased in Haymarket, Virginia.
Headaches can range from mild tosevere and are considered to be one ofthe most common health complaintsin the United States. An estimated 45million individuals experience chronicheadaches each year that cost billionsof dollars in lost productivity.1 Althoughthe majority of headaches are mild andlast only a few hours, some individualsmay experience headaches that persistfor weeks.
In general, headaches are categorizedas primary or secondary. Primary headachesaccount for approximately 90%of headaches and are not related to anunderlying illness.2 Examples of primaryheadaches include tension headache,cluster headache, migraine, and medicationoveruse headaches (also known asrebound headaches).1-4
A headache is classified as a secondaryheadache when it is the resultof another underlying medical condition.Examples include sinusitis, severehypertension, head trauma, hematomas,temporomandibular joint dysfunction,metabolic disorders, cerebral hemorrhage,and meningitis.5-7
Patients experiencing secondaryheadaches,as well as those with chronicheadaches and/or severe headaches,should always be referred forfurther medical evaluation and treatment.Examples of when to seek furthermedical evaluation include individualswith severe head pain or head trauma,headaches that persist >10 days with orwithout treatment, and individuals withhigh fever or signs of infection.2
Tension headaches, also known as musclecontraction headaches, affect an estimated75% of US adults and are consideredto be more prevalent in women.2,5They are characterized by mild pain thatgradually initiates in the area in the backof the head and upper neck. The painis usually bilateral and often describedas tight, pressing, and constricting.1,2,8Tension headaches may last from minutesto days.1-3 Stress, anxiety, fatigue,eye strain, and muscular tension arecommon causes of these headaches.2
Migraine headaches, which affect an estimated20% to 25% of individuals includingchildren, are considered to be the secondmost common type of primary headache.2Migraine sufferers usually have their firstattack before age 30, but migraines alsocan occur in children as young as age 3.1As with tension headaches, women experiencea greater incidence of migraineswhen compared with men, affectingan estimated 18% of women and 6% ofmen.2,5,9 Many women have premenstrualmigraine attacks; however, theycan occur at any time during the menstrualcycle.2 The incidence of migraineheadaches is equal among boys and girlsbefore puberty, and incidence typicallydisappears in boys after puberty.2,5
The pain associated with migraineheadaches often is unilateral and can bedescribed as intense and throbbing.1,2,8The pain may be preceded by an aura,and onset may be sudden. Some individualsmay experience sensitivity to light,noise, or odors, as well as nausea andvomiting.1,2,8 Migraine headaches maylast from hours to days.1,2,8 Factors thatmay precipitate a migraine headacheinclude stress, anxiety, changes in weather,altitude, and/or air pressure, hormonalchanges, use of certain pharmacologicagents (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 are the least occurringof the primary headaches affecting 1% ofthe population.5,8 Cluster headaches aremore prevalent among men, accountingfor 85% to 90% of individuals experiencingcluster headaches.3,5 Cluster headachesare often accompanied by painthat is throbbing and constant and typicallyis unilateral, occurring around orbehind one eye. The affected eye maybecome red, inflamed, and watery.1,2,8These headaches may last 30 to 90minutes. Cluster headaches can occurdaily in clusters of weeks or months.Individuals suspected of having clusterheadaches should be encouraged to seetheir primary health care provider.3,5
APAP = N-acetyl-para-aminophenol (acetaminophen);ASA = acetylated salicylate; NSAID = nonsteroidalanti-inflammatory drug.
Adapted from reference 2.
The types of headaches that are mostoften amenable to self-treatment withthe use of OTC analgesics include tensionheadaches, diagnosed migraines(vascular), and sinus headaches.2Pharmacists are an important sourceof information for patients on the useand selection of these products (Table).These products include acetaminophen,acetylated salicylate, nonacetylated salicylates(choline salicylate, magnesiumsalicylate, and sodium salicylate), andnonsteroidal anti-inflammatory agents.
Prior to recommending any of theseagents, pharmacists should screen forpossible allergies and drug interactions,as well as possible contraindications(eg, individuals with renal and hepaticinsufficiencies, history of gastric ulcers,or those currently taking anticoagulants)and refer patients to seek further medicalevaluation when warranted. Patientswith a history of headaches should beencouraged to seek medical care toidentify potential precipitating factors.Patients also should be reminded aboutrebound headaches that may occur as aresult of excessive medication use andto not exceed recommended dosages.
Pharmacists also can recommendvarious nonpharmacologic measuresthat may alleviate or decrease the occurrenceof headaches, such as relaxationtechniques, avoiding stress, getting anadequate amount of sleep, and eating abalanced diet. It is important to remindpatients to contact their primary healthcare provider if headaches increase inintensity and/or frequency.
Tylenol (Regular and Extra Strength)
Tylenol 8 Hour
Bayer Rapid Headache Relief
Bufferin (Regular and Extra Strength)
Adapted from reference 2.
Excedrin Sinus Headache
Sudafed PE Maximum Strength
Naproxen sodium andpseudoephedrine
Aleve Sinus and Headache
Anacin Advanced HeadacheFormula
Excedrin Extra Strength
Goody's Extra StrengthHeadache Powder
Vanquish Extra Strength
Aluminum hydroxide,aspirin calcium carbonate,magnesium hydroxide
Ascriptin Maximum Strength
Acetaminophen and caffeine
Excedrin Tension Headache