From the Guidelines
For a headache that persists after acetaminophen, especially with a low-grade fever, the patient should consider adding an NSAID such as ibuprofen or naproxen to their treatment regimen, as this combination may provide more effective pain relief than acetaminophen alone 1. When selecting an NSAID, it is essential to consider individual patient factors, such as route of administration and cost, as well as potential side effects and interactions with other medications.
- Ibuprofen (Advil, Motrin) can be taken at a dose of 400-600 mg every 6-8 hours with food, not exceeding 3200 mg per day.
- Naproxen sodium (Aleve) is another option at 220-440 mg every 8-12 hours, not exceeding 660 mg in 24 hours. It is crucial to ensure that the patient is using the appropriate dosage and not exceeding the recommended maximum daily dose, as advised in the clinical guideline from the American College of Physicians 1. If the patient has already tried an adequate dose of an NSAID or acetaminophen and still experiences insufficient pain relief, the addition of a triptan, such as sumatriptan, may be considered, taking into account potential contraindications and side effects 1. However, it is essential to note that opioids and butalbital should not be used for the treatment of acute episodic migraine, as stated in the guideline 1. Ultimately, the choice of medication should be based on individualized decision-making, considering patient preferences and medical history.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Alternative Medications for Headache
If a patient presents with a low-grade fever and headache that won't go away after taking acetaminophen, there are alternative medications that can be considered.
- Ibuprofen is a potential option, as studies have shown it to be effective in relieving pain and reducing fever 2, 3, 4, 5.
- The combination of ibuprofen and acetaminophen may also be considered, as some studies suggest it can provide greater fever control than acetaminophen alone 4.
- However, it's essential to note that the efficacy of these medications can vary depending on the individual and the specific condition being treated.
Considerations for Treatment
When considering alternative treatments, it's crucial to take into account the patient's medical history, current health status, and any potential interactions with other medications.
- Ibuprofen and acetaminophen have been shown to be generally safe and effective for the treatment of pain and fever in both adults and children 3, 5.
- However, as with any medication, there is a risk of adverse events, and patients should be monitored closely for any signs of adverse reactions.
Comparison of Medications
Studies have compared the efficacy of ibuprofen and acetaminophen in various populations, including adults and children.
- A systematic review and meta-analysis found that ibuprofen was more effective than acetaminophen in reducing temperature and relieving pain in children younger than 2 years 5.
- Another study found that ibuprofen was superior to acetaminophen in a range of painful conditions, including acute post-operative pain, dysmenorrhoea, and osteoarthritis 2.