Choosing Wisely

Treating Frequent Headaches with Pain Relievers

When you need them—and when you don’t

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Many people suffer from frequent, severe headaches, including migraines. These headaches need careful treatment, with a focus on prevention. Talk to your doctor about ways to prevent and treat your headaches.

  • Limit use of over-the-counter pain drugs. If you are taking them more than two days a week, cut back.
  • Avoid using prescription drugs containing opioids or butalbital, except as a last resort.

It is easy to use too much pain medicine. This can make headaches worse and cause other medical problems. Here’s why:

Over-the-counter pain medicines can have dangerous side effects.

Aspirin, acetaminophen, and ibuprofen work well for headaches if you don’t use them often.

But if you take these drugs too often, you can get serious side effects. In rare cases, if you often take acetaminophen several days in a row, you can damage your liver. This can happen even if you take just a little over the recommended dose.

Rarely, these drugs can also cause kidney problems. Aspirin and ibuprofen can, at times, cause stomach bleeding.

Watch out for overuse headaches.

If you overuse pain medicines, they may no longer help as much. And you may also get headaches more often. This worsening of headaches is called “medication overuse headaches.” The following drugs are thought to most likely cause overuse head­aches. They may also make you more sensitive to pain:

Prescription drugs:

  • Drugs with butalbital (Fiorinal, Fioricet, Esgic and others)
  • Opioid painkillers
    • hydrocodone (Vicodin and other brands and generics)
    • oxycodone (OxyContin, Percodan, Percocet and others)

Non-prescription drugs that contain caffeine:

  • Excedrin Migraine

Some pain drugs can cause addiction.

Drugs that contain opioids or butalbital can make you drowsy. Long-term use of these drugs can cause addiction or physical dependence, and over­use headaches.

Some people need headache treatment for years, or even decades. They should take addictive drugs only if safer treatments don’t work. If you do have to take addictive drugs, ask your doctor how to avoid overuse and addiction.

Lifestyle changes can help some people with severe headaches.

Often, you can prevent headaches or have them less often if you:

  • Reduce stress, or learn to cope with it more effectively.
  • Drink a minimum of alcohol.
  • Get enough sleep.

If you still get headaches more than once a week, you can consider taking a daily preventive drug.

If you need pain relief during a bad migraine, drugs called triptans work well for most people. They usu­ally have fewer side effects than other prescription drugs. Four of the seven FDA-approved triptans are available as generics, such as sumatriptan (Imitrex).



Advice from Consumer Reports

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2014 Consumer Reports. Developed in cooperation with the American Headache Society. To learn more about the sources used in this report and terms and conditions of use, please visit