painkillers

21 April 2021

Is Acetaminophen/Paracetamol Really “Ineffective”?

A recent headline says: “Paracetamol ineffective for most pain conditions“. So what’s the story when it comes to headache?

Is acetaminophen really effective for headache?

Paracetamol, also called acetaminophen, is still often known by the common brand name Tylenol. Along with aspirin and ibuprofen, it has been a well-known go-to when it comes to over-the-counter drugs for pain management.

The study (link below) was actually a review of 36 systematic reviews published in medical journals. In those reviews, 44 pain conditions were treated with acetaminophen/paracetamol.

Now, things start to get complicated once you drill down that far. Researchers had to watch for bias or errors in studies, or studies that weren’t relevant for whatever reason. And sometimes you end up with a small amount of information for certain conditions. But you do end up with a good summary of what we know, even if what we know is somewhat limited in certain cases. Make sense? 🙂

The study was also mainly focused on whether or not there was “immediate” pain relief, although a couple of conditions did focus on ongoing treatment (osteoarthritis pain and rheumatoid arthritis).

The good news for headache sufferers is that Tylenol for tension-type headache actually turned out to be one of the more successful stories – although, not that successful. Only two conditions made it to “high quality” evidence, but tension-type headache was listed under “moderate quality evidence of efficacy”. In other words, there is fair evidence that acetaminophen/paracetamol will provide some pain relief for that headache. Not exactly a miracle-cure, according to these researchers.

But notice that I only mentioned tension-type headache. What other headaches made the list?

Quite a few – but acetaminophen/paracetamol only had “low quality evidence” for these headaches:

Acute Migraine
Cold related headache

There was also low-quality evidence that it wasn’t effective for:

Migraine in children/adolescents

Of course there are many other headache types, but generally the evidence wasn’t available either way.

In the end, this study mostly tells us that surprisingly there are very few good quality studies of acetaminophen for headache conditions, and that most of the studies out there simply aren’t all that impressive, with the possible exception of tension-type headache. For other conditions, pain relief after surgery did not fare well, and the condition that really did not seem to be helped at all was lower back pain.

There was good news for craniotomy – surgeries in which the skull is opened up, and knee or hip osteoarthritis. However, researchers admitted that “the effect sizes were very small”.

The other good news is that the number of adverse effects was small – but again researchers noted that there wasn’t very much research to be sure.

It might surprise us that such a ubiquitous top-selling pain killer has so little research behind it. Of course, it’s a challenge to research a “pain killer” for every individual condition. If it kills pain, doesn’t it just pain?

Apparently not. And that’s another interesting point in this study. How well it works, and even adverse effects, depend very much on the condition.

—-> From what we know, if you take acetaminophen/paracetamol very occasionally for headache, and it works for you, no worries. But if headache is a significant disruption in your life, say every month or every week, you should be talking to a doctor to find better options. If that pain killer you’re using really isn’t making your life that much better, it’s time to realize that there are many more options out there.

To read the study, published in the Medical Journal of Australia, just click here: The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews

7 December 2015

The Myth-Busting Guide to Migraines and Pregnancy

James Tips 1

If you’re reading this article, you’ve probably already heard some of the common myths about migraines and pregnancy. Some of these myths include:

Headaches during pregnancy are normal and nothing to worry about.
Your migraine attacks will go away when you get pregnant.
You can’t use medications for migraine when you’re pregnant.
You can take “painkillers” during pregnancy, but not migraine meds.

Let’s take a look at these myths and find some solutions.

Do Migraine Attacks Disappear During Pregnancy?

Migraines and Pregnancy This is a difficult question because the statistics vary depending on the source – and depending on the trimester. You can read more details in Migraine During and After Pregnancy, but the short answer is that things probably do improve for some (more than half of) women during pregnancy and even up to a year after the birth of the baby (especially if the baby is breastfed). The biggest improvement is during the second and third trimester.

However, a significant number of women either experience no change, and a few actually get worse. For some women, the medication they have always relied on for migraine no longer works. You’re probably reading this article because you’re one of the many women struggling with migraine during pregnancy.

Are Headaches During Pregnancy Normal?

Common, yes. Normal, no.

Headaches can be dangerous, and that includes migraine headaches and other migraine symptoms (for example, migraine during pregnancy may increase your risk of stroke). In a moment we’ll discuss what to do, but for now let’s remember that your suffering actually can affect both you and your baby. Ignoring your pain because you think it will somehow help your baby is a strategy which probably won’t work well.

Drugs During Pregnancy

There are all kinds of myths about drugs during pregnancy. So let’s be honest. Prescribed medications for migraine may be an excellent choice for both you and your baby. However, not all “painkillers” are perfectly safe.

Also, many non-drug options have good scientific evidence behind them. If you choose not to use medications, you are most certainly not doomed to use “inferior” options.

What to do about Migraines and Pregnancy

Migraine and headaches should not be ignored. Although you have many other things to think about, including so many changes in your body, it is very important that you pay attention to your pain and what it may be telling you. (This actually includes more than just head pain – migraine itself can lead to pain in various parts of the body. Read more about the importance of identifying non-headache pain related to migraine: Warning Flag: Do you have non-headache pain?)

Keep a journal of any pain and other symptoms that you’re experiencing. Make a note of how long a symptom such as headache lasts, how severe it is, what treatment you had for it (if any). For tips on using a simple page-a-week option, check out A Migraine Diary: The Lazy Way. You can also use an app on your phone, a document on your computer – whatever works for you. Your doctor may recommend an option especially for your pregnancy.
Talk to your doctor. If your headache symptoms are new, see a doctor as soon as possible. Some headaches can be a signal of immediate danger. For example, some women with cerebral venous thrombosis may have headache as their only symptom. Neurological conditions, which may include headache as a symptom, are now a significant cause of death among pregnant women. (For more, read Headaches during Pregnancy: Not What You Think?) Even the pain of a tension-type headache or the symptoms of migraine may be dangerous – it’s worth it to check things out and find treatment as soon as possible.
Talk to your doctor before taking “painkillers”. Some people still think that taking Tylenol or Advil is completely safe. We now know that there are risks (see for example this information about anti-inflammatory medications such as ibuprofen, and this research on acetaminophen / paracetamol). Although most doctors still consider acetaminophen/paracetamol to be low risk, these medications may not be the best for migraines and pregnancy anyway, as we’ll see in a moment.
Weigh the risks of medications with your doctor. Going through severe migraine attacks during pregnancy is not good for you or your baby. Of course you do not want to take a medication that will harm your baby, but there are low-risk options available. For example, recent research has shown that triptan medications, abortive drugs that specifically target migraine, are safe for the baby during pregnancy (read more here), though they still may pose some risk to the mother. (See also Triptans are the first line migraine drugs in pregnant women) Your doctor will recommend medications based on your own situation and medical history, but don’t be afraid to consider these options.
Consider non-drug treatments. There are excellent non-drug treatments, and some of them may work better for you than medications. In cases of a severe attack, intravenous magnesium will often stop the pain cycle. Magnesium supplements are also one of the best preventative treatments for migraine overall (more information here). Other excellent treatments include biofeedback, feverfew (particularly in combination supplements such as MigreLief), massage, the SootheAway device, and trigger point therapy, to name just a few. Do talk to your doctor – non-drug options sometimes carry risks as well.
Find support. Although there are many excellent treatments available, they often take time. Don’t be afraid to ask family and friends for support during this time. When you’re experiencing so many changes, with headache or migraine symptoms on top of it all, you’re not going to be able to continue “life as usual”. Be patient, and ask for help if you can.

Finally, here are four things NOT to do when you’re struggling with migraines in pregnancy:

Don’t expect that everything will go as expected: You’ve read 27 books, talked to your friends and gotten advice from your Mom – and this is your 4th baby – but things may still not go as planned. You’re unique, and your baby is unique, and you’ve changed even over the past year.
Don’t panic! Yes, migraine is serious. Yes, you need to talk to your doctor. But you’re probably going to be all right. The above information is supposed to encourage you to pay attention and seriously consider treatment, it’s not supposed to make you panic about every headache. Many many women have made it through pregnancy just fine, and have even had some really happy times, in spite of headaches.
Don’t ignore what your body is telling you: It might seem like it’s just sending too many messages at times, but do your best to pay attention.
Don’t focus on the challenges and problems: Oh, easier said than done! Who does this writer think he is – emphasis on the he?! Yes, there’s no doubt it can be hard. You may need to get more help and support than you expected you would ever need. But you also need to make the choice to see the good things that are happening, if you possibly can. As I have said before, it is possible to experience happiness even when you’re plagued by migraine and/or headache. We can be realistic about the suffering that migraine can cause, and still encourage one another to be thankful for the good around us.

There is good help available for migraine. Following the steps above will give you a higher than average change of finding the treatment you need.

For more information, read about natural solutions for migraines and pregnancy from the Mayo Clinic, and this overview of migraines during pregnancy from WebMD.

2 January 2013

Doctors: Prescribing too many Painkillers? (how we can do better in 2013)

James Tips 3

Are painkillers not being given to patients who really need them? Or are they given out like candy to patients who don’t need them?

Are doctors writing too many prescriptions for painkillers?

The answer is very likely “Yes”.

A recent article by Sophie Borland in the UK claims We’re a nation of painkiller addicts: Doctors writing 62million prescriptions every year. Often, the article states, doctors sign pages and pages of prescriptions given to them by the nurse without checking the details. Many patients are “addicted”, and many won’t tell their doctors how many drugs they’re actually taking.

Yes, we are right to be concerned about doctors who assume patients are “addicted” to painkillers (usually the actual definition of “addicted” is somewhat vague), and so refuse to give medication to patients that could really benefit.

At the same time, patients taking the wrong medications, or medication they don’t need, is a serious, growing problem.

So how can a doctor find a balance? There are patients who are taking medications that are doing more harm than good. There are others who can’t access the medications they truly need.

I don’t believe this issue will be solved by new laws restricting drugs, or by insurance companies creating more policies.

What is really needed are patients who know how to communicate with their doctors, who have organized their medical history (and family medical history) and who keep track of their symptoms and treatments. And we need doctors who will take the time to listen to their patients, take their patients seriously, and take time to find solutions instead of saying take two and call me in the morning for every headache.

Calling all doctors and patients in 2013 – will you take the challenge? It might mean more time, it might mean less money, it might mean taking the long view instead of looking for short term results. But it also might mean that more people that need to be treated will find a solution this year.

More thoughts to ponder:

How to talk to your doctor (from HeadWay issue #052)
How to be a better Headache or Migraine Doctor – what patients want from their doctors

21 June 2012

10 Critical Mistakes First Time Migraine Patients Make

James Tips 6

You’ve just been diagnosed with MIGRAINE. It’s natural to be confused, maybe even nervous or scared.

I’ve spent many years listening to and helping migraineurs. I’ve found that there are some common mistakes that people make when they’re first diagnosed with migraine. Here are my top 10 – maybe one of them will help you to avoid the same mistake!

Expect fast results. No, actually, don’t expect fast results! It’s true that some migraine patients find a solution right away. But a decent trial period for a new treatment is often 3 months – and that’s just trying one treatment. It’s not just migraine – many neurological diseases require this kind of patience (for example epilepsy or muscular distrophy).
Don’t see the doctor again. After all, it’s "just" migraine. I just need some "painkillers" and a rest and I’ll be fine. No – you should go back to the doctor for follow-up. This especially applies when your symptoms change. But really, because migraine takes time to treat and because it’s a disease with complex symptoms and causes, you should be going back for more help.
Be satisfied with a diagnosis of "Migraine". In 1988, the Headache Classification Committee from the International Headache Society came out with a document intended to classify headache disorders, including many different types of migraine. The latest edition is from 2004. Knowing what type of migraine you have means you can find better treatment faster. When you get a diagnosis, check to see if it’s in the document and if your symptoms match. If not, find another doctor and get a second opinion. (A simplified version of the International Classification of Headache Disorders (migraine section) here)
Rely on popular news reports and commercials for information on migraine treatment. News reports and commercials are important ways to get information out to the public. However, they will almost never give you a balanced view of migraine treatment. That’s why crowds of people go after a "miracle" treatment before trying things that are much more likely to actually work for them. Please take news bites with a grain of salt.
Blame it on "stress". "Oh, it’s just stress – I just need to wait until life calms down a bit." Using stress as a scapegoat has kept many, many migraine patients from proper treatment. Stress does not cause migraine, and there’s some debate about whether it even triggers migraine attacks. It’s a factor in the overall picture, but there are likely other issues that you need to deal with in order to properly treat migraine. It’s not "just stress".
Rely on over-the-counter "painkillers". Instead of making use of medications and treatments that can specifically help migraine, patients often take the "shotgun" approach, and take a general purpose painkiller. This often leads to more symptoms and more pain in the long run.
Think you’ve tried "everything" after three different treatments. No one has tried "everything", because in this day and age there are so many treatments (yes, valid ones) for migraine that it could take a lifetime to give them all a try. Sure, it’s discouraging when you’ve tried 5, 10, 15 treatments over many years. Take a break – but don’t give up.
Rely one one kind of treatment. Only try yoga, or just drugs. Only try vitamins, and ignore the rest. Guess what? Many migraineurs have had great success with a variety of treatments. Medications and a change of diet, or the chiropractor and exercise, or magnesium and biofeedback… Don’t be quick to rule out other types of treatment.
Ignore other symptoms. What other symptoms? Well, a very common symptom of migraine is headache. It’s easy to focus on head pain, and ignore other symptoms. But your doctor can treat you better if she knows about other symptoms you’re having, even if they’re not migraine related. Dizziness? Nausea? Sensitive to light? Neck pain? Depression? And guess what? Many migraine symptoms are experienced between actual migraine attacks. The more you can describe your symptoms, the better treatment you’ll get.
What would you add? Oops – I don’t have a #10 mistake! You have some experience – what would you add as a mistake that people make when they’re first diagnosed with migraine? Leave a comment!

2 December 2011

Too Much Tylenol – Over Time?

James Discoveries & Stats, Medications 1

Hopefully most people are aware of the dangers of taking too much paracetamol / acetaminophen. Sometimes people are taking different products that both contain acetaminophen – and inadvertently take too much. It can be very dangerous.

But what about a "staggered overdose"? That is, people who are taking a little too much over a period of time – could they be just as bad off, or even worse off?

Yes, say researchers – a little-by-little overdose could be even more serious than a one time large overdose – and it could be just as life-threatening.

Researchers at Edinburgh University studied the cases of 161 patients who had come to the hospital there over a 16 year period. They also looked at cases of 663 patients with paracetamol/acetaminophen overdose. Those with the gradual overdose were more likely to develop liver and brain problems, need kidney dialysis, or help breathing. The overdoses were also more likely to be fatal.

To make matters worse, the blood test that would identify a one-time overdose will not identify the staggered overdose. Meaning that it will be easy for your doctor to miss.

The message is clear – follow the instructions on the label, check the ingredients of medications you’re taking, and if you need more pain relief, see a doctor. Just taking "a little more" of something to see if it relieves the pain is not the answer.