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Headache tablets are among the most common painkillers that are taken when pain occurs. However, they differ in terms of their active ingredient, time of action or duration of action. You don't know exactly which headache tablets are right for you?

Then you have come to the right place. In our big headache tablet test 2021 we want to present you with all the important information about headache tablets, as well as explain the effect and their various active ingredients. You will also learn about the differences between caffeine and non-caffeine headache tablets and what you should bear in mind when taking them during pregnancy.




Summary

  • Headache tablets contain different active ingredients. The best known are paracetamol, diclofenac, ibuprofen, acetylsalicylic acid and naproxen, which can be classified as acid analgesics and non-acid analgesics.
  • Headache tablets may or may not contain caffeine. Caffeine has a mechanism of action that additionally inhibits pain transmission, which is why pain relief is increased and accelerated.
  • Headache tablets are basically suitable for everyone. For children and adolescents, however, the dosage on the package leaflet should always be followed. Pregnant women should only take painkillers after the 28th week of pregnancy in consultation with their doctor.

The Best Headache Tablets: Our Choices

Buying and evaluation criteria for headache tablets

In the following sections we will show you the aspects you need to consider when choosing between the many possible headache tablets. The criteria you can use to compare headache tablets include:

Below we explain what is important in each aspect.

Dosage

Dosages can vary, especially for tablets. Find out the recommended dose for you beforehand to find the right product. The dosage recommendation can also be found on every package insert and should be studied beforehand. Over-the-counter headache tablets can come in many different dosages. It is important to use the correct dosage so that the headache tablets can work effectively.

Over-the-counter headache tablets should also be taken for a maximum of three to four days in a row and no more frequently than ten days a month. They should always be taken with water, but fruit or herbal tea are also possible. In addition, alcohol in combination with medication should be avoided at all costs.

Duration of effect

The duration of action varies greatly among the different headache tablets. This is mainly due to the different types of people. In petite people, for example, it often happens that the active substance reaches the bloodstream more quickly and thus takes effect more quickly.

The duration of action of the different preparations varies.

Other factors include taking additional medicines or taking them on an empty stomach. This means that the duration of action will always be different.The structure of the tablets also influences the duration of effect. If the tablet already dissolves in the stomach, it will take effect more quickly than if it only takes effect in the small intestine due to an enteric coating.

In the table below we have listed the most common headache tablets and their respective duration of action. In the case of acetylsalicylic acid (aspirin), the headache tablet already dissolves in the stomach, which means it goes straight into the bloodstream. Thus, the full effect can start after only 10 minutes and last up to 6 hours.

Active substance Onset of action Duration of action
Acetylsalicylic acid 10 min up to 6 h
Diclofenac 15-20 min up to 6 h
Ibuprofen 45 min 4 to 6 h
Naproxen 45 min up to 12 h
Paracetamol 15-30 min 6 to 8 h

Diclofenac takes effect after 15 to 20 minutes. The special feature, however, is that this active substance accumulates in the tissue and the effect can therefore last for up to 6 hours. Naproxen is completely absorbed into the bloodstream in the intestine. The active ingredient is therefore only broken down by the body after about 12 hours.

Active ingredient

The most common active ingredients in headache tablets are paracetamol, ibuprofen, diclofenac and acetylsalicylic acid. These can also be combined with caffeine. The active ingredients of headache tablets can be divided into subgroups. A distinction is made between acid analgesics and non-acid analgesics.

Acidic analgesics are characterised by a weak acidic character and a high protein binding, while non-acidic analgesics reach the inflamed tissue through binding to plasma proteins, where the pH value is lower than normal.

  • Acetylsalicylic acid is an acid analgesic that has antipyretic, analgesic and blood-thinning effects. It also has an anti-inflammatory component. It is known as aspirin.
  • Paracetamol is a non-acidic analgesic and has an antipyretic and analgesic effect, but not an anti-inflammatory effect.
  • Diclofenac also belongs to the group of acid analgesics. This is an analgesic and anti-inflammatory agent.
  • Ibuprofen is also an acid analgesic. It has an anti-inflammatory, analgesic and antipyretic effect.
  • For more severe headaches, the active ingredient naproxen is often used. It is anti-inflammatory, analgesic, antipyretic and belongs to the acid analgesics.

For migraine, triptans are recommended above all. These are vasoconstrictive, anti-inflammatory and analgesic agents. Naratriptan and almotriptan are available in Germany.

Side effects

Most headache tablets are well tolerated and their side effects are rare. It is important to follow the instructions on the package leaflet and find out about the side effects.

Side effects that you should be aware of with paracetamol include a reduction in white blood cells, allergic reactions, and a narrowing of the airways. At higher concentrations, side effects can include liver failure, poisoning or kidney failure.

Ibuprofen can cause side effects such as chronic bowel disease, sleep problems or water retention, while acetylsalicylic acid can cause increased bleeding, skin reactions or even visual disturbances.

The most common side effects of diclofenac include gastrointestinal problems, as well as impairment of liver or kidney functions. In addition, the use of diclofenac increases already existing cardiovascular diseases and should not be taken by patients with such a history.

Naproxen is generally well tolerated, but can cause side effects such as hearing and visual disturbances, insomnia or discomfort in the lower abdomen. Overall, headache tablets should not be taken with other medicines or over a longer period of time without prior consultation with the doctor.

Consultation with a doctor or pharmacist is also strongly recommended in the case of previous illnesses.

Age recommendation

The age recommendation varies for different headache tablets. It is stated in the package leaflet and should always be observed beforehand. Paracetamol and ibuprofen are generally recommended for children.

Naproxen may only be taken by children and adolescents from the age of 11 years.

Paracetamol is available without prescription and without age restriction. However, the correct dosage on the package insert should always be followed. Infants under 6 months of age, for example, may only receive 75 mg per kg of body weight per day. Ibuprofen may be taken from 3 months of age, but requires a prescription until 6 months of age.

Diclofenac is sometimes less well tolerated than ibuprofen or paracetamol. Therefore, Diclofenac is only permitted from the age of 6, with a body weight of over 25 kg. Acetylsalicylic acid should not be used in children because in very rare cases it can lead to life-threatening Reye's syndrome when used to treat fever. However, younger children can be given acetylsalicylic acid for painful conditions without fever.

Guide: Frequently asked questions about headache tablets answered in detail

In the following, we would like to answer the most important questions about headache tablets. We have selected the questions for you and will answer them shortly. After reading this section, you will know all the essential background information about headache tablets.

What are headache tablets and how do they work?

Headaches occur in both adults and children and can drastically reduce the quality of life for sufferers. One popular treatment is headache tablets, which you can also get over-the-counter in pharmacies. There is a wide range of tablets that help against headaches.

However, the classic painkillers with the active ingredients acetylsalicylic acid, paracetamol or ibuprofen are mainly used. To help you understand how headache tablets work, we will show you the effects of the best-known headache tablets in the following section.

Effects of headache tablets

The effect of the most common and well-known headache tablets

  • Paracetamol
  • Disclofenac
  • Naproxen
  • Ibuprofen
  • Acetylsalicylic acid

take place in the body under the same principle. The painkillers develop their effect by inhibiting the enzyme cyclooxygenase (Cox). With the help of this small protein, prostaglandins are produced in the body. They are produced in the case of pain, inflammation or injuries to the tissue, but also protect the mucous membranes or trigger labour.

Prostaglandins bind to the pain receptors in the tissue and trigger a signal there that is perceived as pain in the brain. Headache tablets therefore intervene in the pain process by inhibiting the production of prostaglandins.

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To counteract headaches, exercise regularly and get some fresh air. (Image source: Andrew Tanglao/Unsplash)

Acetylsalicylic acid also prevents the platelets from clumping together. It has blood-thinning properties and can thus prevent a blood clot. The blood thus remains thin and blood clots cannot form so easily, which then possibly block a vessel in the heart or brain.

Paracetamol also works in the brain, at the synaptic cleft where the pain stimulus is passed from one nerve cell to the next. There, paracetamol prevents the signalling molecule anandamide from skipping the gap, thus blocking the pain stimulus.

Effect of headache tablets with caffeine

Caffeine enters the bloodstream very quickly and is distributed throughout the body. A study has now shown that caffeine also inhibits the production of prostaglandins in the body. As explained above, these are tissue hormones that play a major role in the development of pain. The active ingredients of painkillers also have the same effect in relieving pain.

The only difference is that they act at a different point in the prostaglandin cascade. Caffeine has a mechanism of action that also inhibits pain transmission. This complements the mechanism of action of painkillers, increasing and accelerating pain relief.

Another study shows that caffeine increases the release of the pain-relieving hormone noradrenalin in the brain.

That is why a combination of caffeine, paracetamol and acetylsalicylic acid is recommended for headaches. This is because the two drugs lower the level of the pain-triggering hormone dopamine. In the case of headache, caffeine is therefore the ideal complement to the two active substances.

Effect of headache tablets during pregnancy

The inhibition of prostaglandin synthesis can have a negative effect on pregnancy and embryonic development. Taking painkillers in early pregnancy can lead to an increased risk of miscarriage and malformations, which probably increases with the dose and duration of use.

In the last third of pregnancy, painkillers with the active ingredient naproxen, ibuprofen or diclofenac should not be taken, as the active ingredient increases the risk of malformations in the unborn child during this time. This includes, for example, kidney damage or blockage of vital vessels.

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In the last third of pregnancy, painkillers containing the active ingredient naproxen, ibuprofen or diclofenac should no longer be taken without prior consultation with a doctor. (Image source: freestocks/unsplash)

When used before birth, ibuprofen suppresses contractions, for example. However, the active ingredients of the painkillers can also enter breast milk, which is why the active ingredients should not be used permanently during breastfeeding.

The amount of amniotic fluid can also decrease, which can lead to problems during birth if it drops below 200 to 500 millilitres. Acetylsalicylic acid does not pose any risks to the unborn baby during the first twelve weeks. After that, however, and around the time of birth, the painkiller should not be taken under any circumstances.

Acetylsalicylic acid reduces the contractility of the uterus and decreases labour. During birth, taking acetylsalicylic acid can also lead to increased blood loss because the active substance inhibits blood clotting.

When and for whom is it useful to take headache tablets?

In principle, headache tablets are suitable for everyone. However, caution should be exercised with children and pregnant women. In children and adolescents, care should be taken not to take the tablets unsupervised or indefinitely.

Also, the correct dosage on the package insert must always be followed. Infants under 6 months of age, for example, may only receive 75 mg per kg of body weight of paracetamol per day. Ibuprofen may be taken from 3 months of age, but requires a prescription until 6 months of age.

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For children, always follow the correct dosages and quantities on the package insert. (Image source :Ana Tablas/Unsplash)

Diclofenac is only permitted from the age of 6, with a body weight of over 25 kg. Naproxen is allowed for children and adolescents only from the age of 11 years.

Pregnant women may take headache tablets up to the 28th week of pregnancy, but any medication should be discussed with the doctor in charge beforehand. 2 days before an operation, the painkillers ibuprofen, diclofenac and naproxen should no longer be taken, while paracetamol can still be used.

Acetylsalicylic acid should not be used in children; it can only be taken with caution from the age of 14.

How much do headache tablets cost?

The price of headache tablets varies depending on the size of the pack and what it contains. Small packs are sometimes available for as little as €2, while larger packs cost an average of €5 to €20. Headache tablets that are specifically for migraine patients are usually more expensive and cost between €8 and €32.

Active ingredient Number of tablets Dosage Price
Paracetamol 20 pieces 500 mg 3-7€
Diclofenac 20 pieces 25 mg 8-12€
Naproxen 20 pieces 220-250 mg 9-10€
Ibuprofen 50 pieces 400mg 2-10€
Acetylsalicylic acid 100 pieces 500 mg 3-8€
Caffeinated tablets 10-20 pieces 400mg Ibuprofen/100 mg Caffeine approx. 7€

The price of headache tablets is mainly related to the active ingredient used and its dosage. For example, a high-dose pack of diclofenac is more expensive than paracetamol. The number of tablets also plays an important role. Packs of 80 tablets naturally cost more than packs of only 20.

Where can I buy headache tablets?

Headache tablets can be bought in pharmacies or drugstores, as well as in online shops.

What types of headache tablets are there?

If you want to buy headache tablets, there are two types to choose from. Headache tablets with caffeine or without caffeine. We have summarised the most important advantages and disadvantages of both types below.

Type Advantages Disadvantages
Headache tablets without caffeine no caffeine withdrawal symptoms, intake time is adhered to, lower risk of unwanted side effects longer waiting time to reach full effect, no accelerated and increased pain relief, no attention-boosting and invigorating effect
Headache tablets with caffeine invigorating and attention-enhancing effect, better tolerability, acceleration and enhancement of pain relief use often longer than recommended, increased risk of adverse renal and gastrointestinal effects, fatigue and nervousness

In the following sections, we explain the differences between the two alternatives.

Headache tablets without caffeine

Caffeine-free headache tablets may take longer to reach their full effect. In addition, the accelerated and stimulating effect is lost. However, this does not tempt you to take headache tablets for longer than is recommended, as no withdrawal symptoms can develop due to lack of caffeine.

The most common active ingredients are paracetamol, ibuprofen, acetylsalicylic acid and diclofenac.

However, it is now difficult to find the headache tablets mentioned without any caffeine at all. Most products always contain small amounts of caffeine. However, caffeine-containing preparations have some disadvantages, so if you want to use headache tablets without caffeine, you should always check the contents of the pack first.

Headache tablets with caffeine

Most headache tablets these days also contain caffeine. Caffeine increases pain relief and speeds up the effect of the active ingredient. Caffeine invigorates, increases alertness, and stimulates heartbeat and breathing. If they are abruptly discontinued after prolonged use, headaches may occur, as well as tiredness and nervousness, which disappear again with renewed caffeine intake.

Thus, one may be inclined to take the tablets longer than recommended, with an increased risk of side effects when discontinuing the tablets. Possible side effects can occur in the kidneys or the gastrointestinal tract, for example. Painkillers can also cause headaches if used for a long time.

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Headache tablets that contain caffeine increase pain relief and speed up the effect of the tablet.(Image sources: Mehrpouya/Unsplash)

You should only resort to headache tablets when pain relief is the main focus and not the invigorating and attention-boosting effect. For acute pain, it is better to take the painkiller together with a cup of coffee.

In this way, you do not attribute the invigorating and attention-enhancing effect of the caffeine to the painkiller, but to the coffee. You will not be tempted to take the tablets more often or for longer than recommended in the package leaflet.

What are the alternatives to headache tablets?

There are several alternatives to headache pills. Homeopathic medicines, for example, are an alternative to headache pills. Among other things, there is willow bark extract, which is recommended for headaches because the active plant substance salicin has a similar effect to acetylsalicylic acid.

Peppermint oil can be used as a natural alternative.

Peppermint oil can also help. It is applied drop by drop, every five minutes to the neck and temples until the acute headache subsides. Another herbal alternative is to take St. John's wort. Due to the caffeine, it is often stated that it leads to a better tolerance of headache pills.

A pain-relieving alternative for migraines is offered, for example, by magnesium, the vitamin B2 riboflavin or the coenzyme Q10. Treatment with Botox injections can also be a sensible alternative to medication for chronic migraine. Sometimes it also helps to drink enough and do sports. If you work too long in front of a computer, it is important to take breaks and go for a walk in the fresh air. Targeted muscle relaxation or meditation can also help.

Image source: Białasiewicz / 123rf

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