From the Guidelines
For earaches and headaches, start with over-the-counter pain relievers like acetaminophen (Tylenol) at 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours, not exceeding maximum daily doses (4000mg for acetaminophen, 1200mg for over-the-counter ibuprofen). According to the most recent and highest quality study 1, the primary goal of treating acute migraine and earaches is to provide rapid and sustained alleviation of pain and restoration of function. Some key points to consider when treating earaches and headaches include:
- Applying a warm compress to the affected ear for 15-20 minutes several times daily to reduce ear pain
- Using over-the-counter ear drops containing benzocaine (like Auralgan) for temporary numbing relief
- Staying hydrated and resting in a quiet, dark room to help with headache symptoms
- Seeking medical attention if the earache is accompanied by fever, discharge, severe pain, hearing loss, or if symptoms persist beyond 2-3 days, as prescription antibiotics may be needed for an infection
- Consulting a doctor for headaches that are severe, persistent, or accompanied by other concerning symptoms like vision changes or neck stiffness. The 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1 provides evidence-based recommendations for the treatment of headaches, including the use of over-the-counter pain relievers, prescription medications, and non-pharmacologic therapies. It's also important to note that the use of analgesics should be closely monitored to avoid rebound headaches, and that acetaminophen alone has not been shown to be beneficial in migraine treatment, but it is effective in combination with aspirin and caffeine 1. Additionally, the guideline recommends against the use of gabapentin for the prevention of episodic migraine (EM) and suggests the use of ibuprofen (400 mg) or acetaminophen (1000 mg) for the treatment of tension-type headache (TTH) 1. Overall, the treatment of earaches and headaches should be individualized and based on the specific needs and symptoms of the patient, with the goal of providing rapid and sustained relief from pain and restoring function.
From the Research
Treatment for Earache
- Earache is a common symptom of acute otitis media (AOM), and analgesic treatment is regarded as the cornerstone of AOM management in children 2, 3.
- Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve pain in children with AOM 2, 3.
- Low-quality evidence suggests that both paracetamol and ibuprofen as monotherapies are more effective than placebo in relieving short-term ear pain in children with AOM 2, 3.
- There is insufficient evidence of a difference between ibuprofen and paracetamol in relieving short-term ear pain in children with AOM 2, 3.
Treatment for Headache
- Migraine headaches are a neurologic disorder characterized by attacks of moderate to severe throbbing headache, and over-the-counter medications are an important component of migraine therapy 4.
- Acetaminophen, ibuprofen, naproxen, and aspirin are commonly used over-the-counter medications for migraine attacks, and have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks 4.
- These medications have fewer and less severe adverse effects, more favorable routes of administration, and reduced abuse potential compared to prescription medications 4.
Comparison of Treatments
- The evidence is very uncertain about the effect of ibuprofen versus paracetamol on relieving short-term ear pain in children with AOM, as well as for the effectiveness of ibuprofen plus paracetamol versus paracetamol alone 2, 3.
- Further research is needed to provide insights into the role of ibuprofen as adjunct to paracetamol, and other analgesics such as anaesthetic eardrops, for children with AOM 2, 3.