02.Your treatment options
- Most tension-type headaches respond temporarily to OTC analgesics such as aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Nurofen) or naproxen (Aleve). Acupuncture, physical therapy, cognitive behavioural therapy and relaxation techniques may also be helpful for dealing with frequent headaches.
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Mild migraines can often be successfully treated with aspirin, paracetamol or NSAIDs (including ibuprofen, naproxen or diclofenac). For more severe migraines, your doctor may prescribe triptans, anti-emetics or ergotamine compounds. Opioids (such as codeine or pethidine) are not recommended.
There are several prescription medicines that, taken daily, may help reduce the frequency and/or severity of migraines. Your doctor can determine what’s likely to help you, with options including beta blockers, some anti-depressants, anti-epileptic medications and calcium channel-blockers.
A specific headache diagnosis is the best way to obtain the right treatment, whether it be medication or non-medication related strategies. If you’ve consulted a doctor in the past and the prescribed treatment wasn’t successful, it’s worth going to the doctor again for a different prescription - or seeking a second opinion.
Can painkillers really 'target pain'?
Scanning pharmacy or supermarket shelves could have you believing there are specific painkillers for different parts of the body: tension headache, migraine, back pain, neck pain, period pain and osteoarthritic pain.
A closer look at the ingredients reveals they are often identical from product to product. Nurofen Migraine Pain contains 200mg of ibuprofen, the same as Nurofen Back Pain, Nurofen Period Pain, Nurofen Tension Headache Pain and plain old Nurofen Tablets. Panadol Back + Neck Pain contains the same 500mg of paracetamol as regular Panadol tablets, while the eight-hour sustained-release Osteo and Back+ Neck products both contain 665mg.
Despite what dramatic marketing claims and graphic images on ads may suggest, painkillers act systemically rather than locally. The drug is absorbed into your bloodstream and accesses most tissues in your body, not just the site of pain.
Different types of painkiller will act differently on pain:
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Aspirin and other NSAIDs stop or reduce the production of prostaglandins – hormone-like substances that can trigger pain signals to the brain. They act in both the brain and the painful area to reduce pain and inflammation.
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Paracetamol reduces the production of prostaglandins in the brain and central nervous system rather than at the site of pain, and has no anti-inflammatory effect.
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Opioids, such as codeine, affect the brain’s responses to the pain message, rather than by acting on prostaglandins.
So while it’s true that NSAIDs address pain at its site as well as in the central nervous system, a product marketed for back pain doesn’t only go to your back – it will treat any pain, anywhere. Paracetamol or codeine act in the central nervous system, not at the site of pain. So you don’t need to empty your wallet by filling your medicine chest with a different painkiller for each part of the body.
Alternative therapies for migraine
Feverfew and butterbur are herbal remedies that have been found to reduce the incidence of migraines – as have riboflavin (vitamin B2), magnesium (oxide or chelated) and Coenzyme Q10 supplements. Our sister organisation in the US,
Consumers Union, has put compiled a summary of studies of herbal and dietary
supplements for migraines on its Consumer Reports on Health website.
A recent review of 22 studies found consistent evidence that acupuncture is also useful for treating acute migraine attacks and appears to be at least as effective as, or possibly more so than, preventative drug treatment, with fewer adverse effects.