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Countering the pain adequately

The Germans consume less painkillers in comparison with Europe and the rest of the world. Taking not too much and not too little for headache is important as both extremes could be promoting factors for a chronic course.
Isabel Weinert
Marta Campell
19.09.2019  10:00 Uhr

For the self-medication of tension headaches, the German Migraine and Headache Society recommends a monotherapy with acetylsalicylic acid (ASS), Ibuprofen or Diclofenac as drugs of first choice. Fixed combinations of ASS, paracetamol and caffeine or paracetamol and caffeine also rank among the drugs of first choice. Caffeine demonstrably enhances and accelerates the effect of analgesics. By now, there are a number of preparations which correspond to the first fixed combination mentioned above, for example in Doloversa®, Melabon® K, Ratiopyrin® or Thomapyrin® intensive. Here the patient needs to take two tablets in each case in order to reach the recommended dose. The other fixed combination of paracetamol and caffeine is not available on the German market in the recommended dosage, but they are available with a slightly different substance (for example Temagin® paracetamol plus, Vivimed®). According to the German Migraine and Headache Society, the drug of second choice in the case of self-medication of tension headaches is paracetamol as a monotherapy.

Faster effectivity

Using galenic formulations such as effervescent tablets or hard tablets with an increased share of exploders and reduced grain size of the active substance, the producers succeeded in achieving a faster response. In some preparations Ibuprofen is contained in form of a lysinate in order to obtain a faster effect. Amino acid is acting as a solubilizer. An optimal effect will, however, only be obtained if the medication is not taken on a full stomach.

Sometimes customers report that a common painkiller for headaches does not have any effect in their case. The individual response does, in fact, vary. Even medicines that are in line with the evidence-based recommendations, may have no effect or only a weak one on patients suffering from headaches. So, if a patient is not satisfied with the effect of an analgesic it can be worthwhile to try another active ingredient.

In the case of self-medication, the medicines used for headaches should only be taken over a short period of time, that is maximally three to four days. If the symptoms have not disappeared during that time, the person concerned should have the causes of persistent or recurrent headaches clarified by a doctor. Another reason for the time limit is the fact that the frequent and prolonged consumption of painkillers for headaches in itself can lead to headaches.

Essential Oil

Apart from the classic analgesics, there is an alternative that has proven effective in the treatment of tension headaches: peppermint oil (oleum menthae piperitae) in a 10% ethanolic solution. The solution should be applied to the forehead and temples. Apparently, due to the skin irritation, a relaxing effect is achieved. If needed, the patient can apply the solution several times in intervals of 15 minutes.

Headaches are the most frequent pain disorders in children and adolescents. They can have many causes, for example hunger, dehydration, fatigue or defective vision. Slight symptoms can often be improved by drinking more, using a wet cloth on the forehead or – with children from six years on – by applying a peppermint oil solution to forehead and temples. The latter should be used sparingly to prevent eye irritation caused by the vaporizing oil. Out of the OTC analgesics, only paracetamol and ibuprofen have been approved for use by children. ASS must not be used for children under twelve years of age.

Also Children are affected

Apart from tension headaches there are also other types of headaches, for example those which stem from the cervical spine, cluster headaches and headaches caused by the overuse of medication. Especially in the case of very severe pain or certain side effects, PTA and pharmacists should always refer the patient to a doctor for clarification. Next to tension headaches, the most frequent headache disorder is migraine. In Germany, an estimated 7 to 14 percent of the population are suffering from recurrent bouts. Women are affected about twice as frequently as men. Children too can have migraine. About four to five percent of the girls and boys in Germany have to struggle with it.

In the case of self-medication, the recommendations of the German Migraine and Headache Society for the treatment of acute migraine are similar to those for tension headaches. They differ, however, inasmuch as paracetamol as well as phenazone and naratriptan are recommended as drugs of first choice. Diclofenac as well as the fixed combinations of paracetamol and caffeine, however, have not proven effective for the treatment of migraine.

Deutsch/German Englisch/English
Alternative alternative
Anfälle bouts
Brausetablette effervescent tablet
Chronisch chronic
Cluster-Kopfschmerz cluster headache
Fixe Kombination fixed combination
Halswirbelsäule cervical spine
Kopfschmerz headache
Migräne migraine
Monotherapie monotherapy
Pfefferminzöl peppermint oil
Schläfe temple
Selbstmedikation self-medication
Spannungskopfschmerz tension headache
Stirn forehead
Wirkeintritt response
Wirkungslos ineffective

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