Occasional: For a garden-variety tension headache, first try acetaminophen (Tylenol), says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at Beth Israel Medical Center in New York City. "It's the safest of all the over-the-counter pain relievers at recommended dosages," he says. If your headache doesn't disappear, choose a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen (Advil) or naproxen sodium (Aleve), Fishman suggests. Aspirin also works, but because it has a slightly higher risk for gastrointestinal bleeding, most doctors don't recommend it for more than a few days in a row, says Portenoy. Aspirin for heart disease prevention is taken at a lower dose.
You need something stronger: If the pain persists, talk to your doctor about a prescription-strength NSAID (Voltaren, Anaprox, Celebrex). For severe headaches, you may be prescribed drugs that contain butalbital (a barbiturate), caffeine, and either aspirin (Fiorinal) or acetaminophen (Fioricet). Migraine sufferers are often helped by triptans (like Imitrex or Zomig). If the headache becomes chronic, your best bet is to work with a doctor or pain specialist to find the right drug cocktail (this is true with any kind of ongoing pain; go to painmed.org/patient to find a specialist). Drug options include short-acting opioids (Percocet, Vicodin), antidepressants such as Effexor or Cymbalta, which double as analgesics, and antiseizure medications like gabapentin (Neurontin) or pregabalin (Lyrica), recently approved as the first drug to treat fibromyalgia.
2. Menstrual Cramps
Regular monthly discomfort: Take an over-the-counter NSAID. "Studies have shown that these are more effective than acetaminophen in reducing this kind of pain," says Portenoy.
You need something stronger: Your doctor may suggest a prescription-strength NSAID. Another option is suppressing your cycle with birth control pills, or—if the pain is bad enough—a short-acting opioid.
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