What is the recommended treatment for mild headaches?

Treatment for Mild Headaches

For mild headaches, start with over-the-counter NSAIDs (ibuprofen 400-800 mg or naproxen sodium 500-825 mg) as first-line therapy, which are superior to acetaminophen alone and have strong evidence for efficacy. 1, 2

First-Line Treatment Options

• Ibuprofen 400-800 mg is the preferred initial choice for most mild headaches, with proven efficacy and can be repeated every 6 hours as needed 2
• Naproxen sodium 500-825 mg provides longer duration of action (up to 12 hours) and may prevent headache recurrence, making it ideal for patients who need extended relief 1, 2
• Aspirin 1000 mg is another evidence-based option with proven efficacy for headache relief 1, 2

Enhanced Combination Therapy

• Adding caffeine to an NSAID significantly boosts effectiveness - the combination of aspirin 500 mg + acetaminophen 500 mg + caffeine 130 mg is substantially more effective than acetaminophen alone 1, 2
• Caffeine enhances analgesic absorption and provides synergistic pain relief through its adjunctive effects 3, 2

Acetaminophen: Limited Role

• Acetaminophen 1000 mg alone has inferior efficacy compared to NSAIDs, with a number needed to treat (NNT) of 12 for pain-free response at 2 hours 4
• Acetaminophen should be reserved for patients with contraindications to NSAIDs (such as severe kidney disease, GI bleeding history, or aspirin-induced asthma) 2
• The combination of acetaminophen with aspirin and caffeine is effective, but acetaminophen as monotherapy is not recommended 3

Critical Frequency Limitation to Prevent Medication-Overuse Headache

• Limit all acute headache medications to no more than 2 days per week to prevent medication-overuse headache, which paradoxically worsens headache frequency and can lead to daily headaches 1, 2
• Patients using acute medications more frequently than twice weekly require preventive therapy rather than continued acute treatment 1, 2

When to Escalate Treatment

• If NSAIDs fail after treating 2-3 headache episodes, this indicates moderate to severe migraine requiring prescription medication (specifically a triptan) 2
• For moderate to severe attacks, combination therapy with a triptan plus NSAID (such as sumatriptan 50-100 mg plus naproxen 500 mg) provides superior relief compared to either medication alone 1

Important Safety Considerations

• Avoid NSAIDs in patients with creatinine clearance <30 mL/min, active GI bleeding, or aspirin/NSAID-induced asthma 1
• Never use opioids or butalbital-containing medications for routine headache treatment due to risk of dependency, rebound headaches, and loss of efficacy over time 3, 1, 2

Red Flags Requiring Urgent Evaluation

• Seek immediate medical attention if headache includes thunderclap onset, fever with neck stiffness, progressive worsening pattern, neurological symptoms, awakens patient from sleep, or is worsened by Valsalva maneuver 3, 2

Timing of Administration

• Take medication as early as possible during the attack while pain is still mild to maximize efficacy 3, 1