OTC Pain Relievers and Fever Reducers (cont.)

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Migraine or vascular headaches

Migraine or vascular headaches are due to dilation (widening) of blood vessels in the head. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys are affected more than girls by migraine headaches. However, as a child nears adolescence, girls are affected more than boys. An estimated 6% of men and up to 18% of women will experience a migraine headache. Although many patients use the expression "migraine" to describe any particularly painful headache, many of these are actually muscle contraction headaches. OTC medications for pain may be quite effective for treating migraine headaches. However, prescription medications that are specifically formulated for treating or preventing migraines are often necessary.

Sinus headache

A sinus headache is caused by inflammation or an infection or blockage of one or more sinuses. The pain often is limited to the area around the eyes or the forehead. The pain may occur upon awakening, and may decrease in intensity after the person stands or sits up for a period of time. In addition to analgesics, OTC decongestants can be effective to help drain the sinuses.

What causes fever?

Most fevers last only a few hours or days and are not dangerous; however, they may cause a great deal of discomfort. A rectal temperature of greater than 101.8 F (38.8 C), an oral temperature of more than 100 F (37.8 C), or an armpit temperature of greater than 99 F (37.2 C) is considered significantly abnormal. Fevers are usually due to viral or bacterial infections; however, they also can be due to cancers, injury to tissue (for example, heart attacks), hyperthyroidism, other illnesses in which there is inflammation, and dehydration. Additionally, many different drugs have been reported to cause "drug fever."

Harmful effects of fever (for example, dehydration, changes in consciousness, seizures, or coma) are likely to occur at temperatures above 106 F. Lower fevers can be dangerous in persons with heart disease, since fever increases the effort required by the heart to pump blood.

Two percent to four percent of children between the ages of 6 months and 5 years (usually before age 3) with high fevers will experience febrile seizures; though these seizures generally last no more than 15 minutes. Moreover, children who experience febrile seizures have a higher risk of developing epilepsy later in life.

What are the different classes OTC pain relievers and fever reducers?

The three classes of OTC analgesic/antipyretic medications are:

  • Salicylates: aspirin (also called acetylsalicylic acid or ASA), choline salicylate, magnesium salicylate, and sodium salicylate;
  • Acetaminophen
  • Nonsteroidal antiinflammatory drugs (NSAIDs): ibuprofen, naproxen sodium, and ketoprofen. (Aspirin is also an NSAID, but it is considered separately from the other NSAIDs because it has some unique properties.) Each of these drugs is discussed in detail below.

In most circumstances, these medications all have very similar abilities to relieve pain and fever. Their onset of action (the interval from the time of ingestion to the start of pain relief) also are similar. Naproxen sodium may have a somewhat longer duration of pain relief (analgesia) than the other NSAIDs or aspirin. At high doses, salicylates and NSAIDs suppress inflammation and are, therefore, particularly useful in treating inflammatory diseases, such as arthritis. Acetaminophen does not have anti-inflammatory actions.

Many OTC analgesics are available in combination with other drugs. There is some evidence that caffeine and antihistamines enhance the effects of analgesics. Thus, caffeine increases the pain-relieving effects of aspirin and ibuprofen, and the antihistamines orphenadrine and phenyltoloxamine enhance the pain-relieving effects of acetaminophen. Combinations of decongestants with analgesics are logical only when nasal or sinus congestion are present, such as with sinus headaches.


Aspirin can damage the lining of the stomach and duodenum, thereby causing abdominal pain, bleeding, and/or ulcers. As a result, 1 in 5 persons who take aspirin in a dose of 2.5 grams per day or more develops ulcers and about 1 in 6 will lose enough blood from gastrointestinal bleeding to develop anemia. In an attempt to reduce the potential for these complications, some aspirin-containing tablets have been coated with a special coating that prevents the tablet from dissolving until it is past the stomach and duodenum. These "enteric-coated" aspirin products may reduce the frequency of abdominal pain, but not the bleeding or ulcers. Moreover, the onset of pain relief is delayed with enteric-coated aspirin because it takes more time for the tablets to dissolve.

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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