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11 November 2022

Falling from Favour: Paracetamol / Acetaminophen

James Discoveries & Stats, Information, Medications 0

The story of acetaminophen/paracetamol, commonly associated with the brand name Tylenol, is a strange one. A researcher studying treatments for worms requested one chemical and received the wrong one. The worms didn’t mind it, but it did seem to fight fever.

It was in the late 1800s that acetaminophen was first used to fight fever and pain in Germany. But it was never widely used until it came to market in the USA and the United Kingdom in the 1950s.

As might be expected, a drug to treat pain and/or fever quickly became popular. Not only by itself, but in combination with other medications under numerous brand names. Few medications are taken with as much frequency as this one.

As is the case with many drugs, we’re not really sure how it works. The most common theory today is that it blocks COX (cyclooxygenase) enzymes in the brain, thus keeping pain signals from being transmitted. Read more from Tufts University School of Medicine: How Does Acetaminophen Work?

Being so common, problems started to arise with overdoses. It’s easy to take too much, or to take two products that contain paracetamol without carefully checking the labels. (By the way, unlike some “painkillers”, taking more of this one doesn’t increase its power – so never take more than the recommended amount thinking it will help you more.)

Liver damage, or even liver failure, from paracetamol is very common. Concerned, the FDA changed its recommendations in 2014. (See also How to Protect Your Liver from Acetaminophen) Added to that have come concerns about hypertension.

The European Journal of Pain published an article entitled “A history of errors, failures and false decisions”, calling it “probably one of the most dangerous compounds in medical use”.

When we thought that taking some during pregnancy was one of the safer options, concerns began to emerge regarding the development of the baby – in particular, “neurodevelopmental, reproductive and urogenital disorders”, and that paracetamol “interferes with sex and thyroid hormone function essential for normal brain development”. Also see Acetaminophen / Paracetamol – Not safe during Pregnancy after all? It seems like there have been a lot of assumptions about this medication’s safety, but not as many studies as such a ubiquitous drug deserves.

The “good” news may be that this may not be your best choice for headaches after all. Sure, if it works for the occasional tension-type headache, there may be no reason to change. But if you’re popping a pill every month, or every week, it’s time to talk to your doctor. But when it comes to other headache conditions such as migraine, there are so many better options that you may want to avoid acetaminophen altogether. See Is Acetaminophen/Paracetamol Really “Ineffective”?

Recent studies remind us of some key issues that we’ve talked about before:

Even “safe” medications should be used rarely, if possible. They all have risks.
You are an individual, and you need to find what works for you.
Lifestyle, such as regular movement and what you eat, are still king, and can never be replaced by a pill.
Read labels.
Getting headaches on a regular basis? Talk to a specialist. There are probably better treatments than over-the-counter painkillers.

Paracetamol is a unique drug with a strange history. It has helped many, but as our knowledge continues to expand, we may find that it has had its day. This will be an interesting story to keep watching.

19 September 2009

My Hair Hurts! Migraine and Allodynia

James Information, Medications 28

Like about 2/3 of migraineurs, allodynia is one of the wonderful symptoms that comes along with many of my migraine attacks. It’s always uncomfortable, and usually painful, and believe it or not most people have never heard of it.

Allodynia. Migraineurs often suffer from cutaneous allodynia – that is, sensitivity and/or pain when the skin is touched. Most common in women, it often comes during the headache stage of a migraine attack (if there is a headache at all), but for many people it comes before, and is a kind of "warning signal". The skin becomes so sensitive, that it may feel like your "hair hurts". Running a comb through your hair can be excruciating.

Though allodynia on the scalp is the most commonly known, some people (like me) get sensitivity on other parts of the skin – such as the arms. If you wear jewelry, it might become impossible during an attack. Just wearing a shirt can cause a great deal of pain – that’s right, just the brushing of a sleeve against your skin. Standing near a stove, even standing in the wind, can be a real problem.

Muscle tenderness could also be a related symptom, especially in the head and neck.

Studies are showing us how allodynia fits into a migraine attack. It’s believed that the hypersensitivity is a part of the migraine chain reaction, where neurons become sensitized. A vicious cycle of hypersensitivity and pain is a main feature of the migraine reaction in the brain.

Though for some the symptom is brief and not worth comparing to other symptoms (like headache or nausea), for others it can be very debilitating. It also may be that people with allodynia are at risk for worsening migraine – where you start having attacks more and more often. So what about treatment?

Treating Migraine with Allodynia

We’re still waiting for research on many of the new medications that are being used for migraine. It’s been suggested that one of the older (and now less frequently used) medications, may help with allodynia in some patients. That is dihydroergotamine (DHE).

Another class of drugs that might help is a cyclooxygenase inhibitor, a type of anti-inflammatory drug. There have been concerns about Cox2 inhibitors and their link to heart problems. However, if your symptoms are severe you may want to give one a try after talking to your doctor.

Some studies have suggested that triptan drugs (like Imitrex) don’t work well in the presence of allodynia. Today, this is being questioned.

Probably your best bet is to treat migraine as a whole, and if you’re taking abortive medication take it as soon as you feel the migraine attack starting. Generally speaking, if you find a treatment that fights your migraine attacks, you should also find your allodynia decreasing.

There is one thing that can make allodynia worse – and that is opioid drugs, such as codeine and meperidine (Demerol). In most cases these are better avoided in migraine treatment, but allodynia may give you another reason to look for other options.

Allodynia and Migraine – Summary

Pain on your skin, especially the scalp and arms, is very common in migraine. It’s not your imagination! It’s actually an important feature of migraine that is teaching us more about what happens in the brain during an attack.

As you treat your migraine disease, pay attention to increasing or decreasing allodynia, and discuss it with your doctor. You may be able to find better treatment options, using allodynia as another clue.