Management of Headache in Influenza
For headache associated with influenza, use ibuprofen or naproxen as first-line treatment, with acetaminophen as an alternative for patients who cannot tolerate NSAIDs. 1
First-Line Treatment Approach
NSAIDs are the preferred agents for influenza-related headache:
- Ibuprofen is specifically recommended by the British Infection Society and British Thoracic Society for treating fever, myalgias, and headache in patients with influenza-like illness 1
- Naproxen is equally effective for symptomatic relief 1
- These agents address both the headache and the systemic inflammatory symptoms (fever, myalgias) that commonly accompany influenza 2
Alternative Treatment
Acetaminophen (paracetamol) 1000 mg can be used when NSAIDs are contraindicated:
- Consider this option in patients with gastrointestinal risk (history of ulcers, bleeding) or cardiovascular risk 1
- While acetaminophen has demonstrated efficacy for headache treatment, it is less effective than NSAIDs for the full constellation of influenza symptoms 3, 4
Critical Dosing Principles
Use the lowest effective dose for the shortest duration necessary 1:
- Avoid aspirin in children under 16 years due to Reye's syndrome risk 1
- For children with high fever (>38.5°C), ibuprofen is appropriate 3
Supportive Measures
Combine pharmacologic treatment with supportive care 3:
- Adequate fluid intake
- Rest
- Avoid smoking
- Consider short-duration topical decongestants if nasal congestion is prominent 3
Red Flags Requiring Urgent Reassessment
Patients must seek immediate medical attention if they develop 1:
- Difficulty breathing or painful respiration
- Hemoptysis (bloody sputum)
- Altered mental status (drowsiness, disorientation, confusion)
- Persistent fever for 4-5 days without improvement or with worsening symptoms 1
Clinical Context
The presence of headache in influenza is strongly associated with other markers of innate immune response including myalgia, fever, shivering, and asthenia 2. While headache itself is associated with increased sick leave and school absenteeism, it paradoxically correlates with lower hospitalization rates, suggesting it may be a marker of less severe systemic disease 2. This treatable symptom should be systematically evaluated and managed to reduce disability 2.