Paracetamol headache

Acetaminophen (paracetamol) has good analgesic efficacy in toothaches and headaches, but is of little use in inflammatory and visceral pain. Its mechanism of action remains unclear. It can be administered orally or in the form of rectal suppositories (single dose,... 

Paracetamol is used for the rapid relief of fever, pains and aches such as headache, earache, toothache, fibrositis, myalgia, neuralgia, arthralgia, osteoarthritis and postoperative pain. 

A 76-year-old woman taking lisinopril 20 mg/day and metoprolol for hypertension developed headaches, nausea, and a tingling sensation in her arms. Her serum sodium was 109 mmol/1, with a serum osmolality of 225 mosm/kg, urine osmolality of 414 mosm/kg, and urine sodium of 122 mmol/1. She had taken diclofenac 75 mg/day for arthritic pain for 6 years and naproxen for about 1 month. Propoxyphene napsylate and paracetamol had then been substituted and zolpidem had been started. A diagnosis of SIADH was postulated and thyroid and adrenal causes were excluded. Lisinopril was withdrawn and fluid was restricted to 100 ml/day. The serum sodium gradually corrected to 143 mmol/1. 

Mr AG can be advised to take paracetamol up to 4 g daily (i.e. one or two 500 mg tablets, every 4-6 hours maximum eight tablets per 24 hours) to relieve his headache. If the headache persists or is severe he should arrange to see his GP to discuss his treatment. 

Mr JC, age 21, who has recently changed his job to become a painter and decorator, comes into your pharmacy and complains of severe nasal congestion, headache and blurred vision for 3 days. His has recently suffered cold symptoms. He took two paracetamol tablets which helped briefly. A friend has advised that he takes an antihistamine to treat these symptoms. And he asks for your advice and recommendations. 

Sue, who is 50 years old, works as an administrator in a busy office. She had to take the afternoon off again, in spite of the heavy workload in the office. She has been having severe headaches recently with visual disturbances these make her feel nauseous, and sometimes vomiting occurs. She was treating the headaches with painkillers such as paracetamol/acetaminophen for a while however, recently these drugs do not seem to help. Nobody in her family has suffered from any headaches like this, and she has never had any accident or injury to her head. She finally decides to see her family doctor. The doctor has now made a diagnosis and has prescribed sumatriptan. 

A 50-year-old woman, who had taken one conjugated estrogen tablet daily for hormone replacement therapy and tricalcium phosphate twice daily for osteoporosis, took zolpidem 10 mg for insomnia and paracetamol 500 mg for a headache at bedtime (31). She began to have visual hallucinations within 20 minutes, lasting for about 30 minutes, and then her vision returned to normal. She only partially recalled the event. She had never taken zolpidem before and had not had any such disturbances in the past. 

A 58-year-old man developed stomatitis and widespread edematous erythema with papules and pustules after taking a combination of carbamazepine and paracetamol for 2 days, a most unusual treatment for headache and fever (62). The stomatitis improved but the eruption persisted for 2 months and was diagnosed as eosinophilic pustular folliculitis, a disorder that is rarely drug-induced. Recovery was achieved with glucocorticoid therapy. 

Twelve cases of analgesic-related headache have been reported in children aged 6-16 years, half of whom were taking paracetamol in combination with codeine (4). Headaches occurred on at least 4 days per week and... 

A 20-year-old woman, who had previously taken paracetamol without adverse effects, took paracetamol 1 g and codeine 60 mg for a headache. After 3 hours she developed severe upper abdominal pain radiating to the back. The abdominal pain resolved within 24 hours of the administration of phloroglucinol and tiemonium. Her serum amylase activity was raised 3-fold and the serum lipase 15-fold. Other biochemical parameters, abdominal ultrasound, and an MRI scan were normal. Contrast-enhanced computed tomography showed pancreatic edema. 

This study suggests that codeine dependence may be more common in the general population than has been previously thought. The authors suggested that it is important to identify those with codeine abuse or codeine dependence, since they may be using substantial doses of codeine for apparently little benefit compared to the risks. Furthermore, there are also health risks of associated chronic use of paracetamol and a potential for analgesic rebound headache. 

During the first days of treatment, virtually all patients have a flu-hke sjmdrome with fever, chills, tachycardia, malaise, headache, arthralgias and myalgias, but tachyphylaxis usually develops after 1-2 weeks of treatment (20). Late febrile reactions are rarely noted (21). Although the severity increases with the dose, the flu-hke syndrome is rarely treatment-limiting and it can be partly prevented by the prophylactic administration of paracetamol (acetaminophen). The acute release of fever-promoting factors, for example the eicosanoids, IL-1, and TNF alfa, secondary to interferon alfa is the suggested mechanism. 

A 30-year-old man and a 66-year-old woman had taken paracetamol 1 g intermittently for headaches and other non-specific indications. Routine blood testing showed thrombocjdopenia (50 x 10 /1 and 45 x 10 /1 respectively). They both stopped taking paracetamol, and their platelet counts rose to normal within 7-10 days. Their sera contained antibodies (IgG or IgA) that recognized normal platelets in the presence of the metabolite paracetamol sulfate. 

The tablets are for her. She gets headaches particularly when revising and it stops her concentrating. The headaches are not very severe and she has used paracetamol in the past but wondered if Nurofen would be better. She has an inhaler ( it s for wheezing ) but rarely uses it. She used to have quite a lot of chest trouble as a child but it is very rare now. 

Explain to her that Nurofen would not really be suitable for her because of her history of chest problems. She may well be sensitive to ibuprofen, the ingredient in Nurofen. Also tell her that aspirin could cause her problems and that paracetamol is the best treatment for her. You could also check whether or not she has seen an optometrist for an eye test recently. She may also get some relief from the headaches if she had regular breaks, preferably taking a walk outside to clear her head. 

Isometheptene is a sympathomimetic, used in the treatment of migraine and throbbing headache for its vasoconstrictor effect. It is combined with paracetamol in one proprietary product. 

Paracetamol, aspirin and ibuprofen can be used to reduce fever, if present, and ease headache and muscle pains in influenza and general discomfort with colds. 

An epileptic woman taking phenobarbital 100 mg daily developed hepatitis after taking paracetamol 1 g daily for 3 months for headaches. Within 2 weeks of stopping the paracetamol her serum transaminase levels had... 

A single intramuscular dose of recombinant human interferon alfa-2a 18 million units was given to 8 healthy subjects alone, or after one day of either aspirin 650 mg every 4 hours, paracetamol 650 mg every 4 hours or prednisone 40 mg daily, for a total of 8 days. None of these additional drugs reduced the interferon adverse effects of fever, chills, headache, or myalgia. Only prednisone appeared to reduce one of the two measures of interferon activity. In a later similar study by the same research group, the effect of the same drugs and doses (started 3 days before the interferon) was evaluated with a lower dose of interferon alfa-2a (3 million units). When data for aspirin, paracetamol or prednisone was combined the... 

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