# Which works better on headaches: aspirin or Tylenol? **URL:** \ **Category:** Factual Questions\ **Created:** [June 2, 2003, 4:26pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154 "2003-06-02T16:26:00Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![lissener](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lissener/32/6139_2.png) [@lissener](https://boards.straightdope.com/u/lissener)\ **Post date:** [June 2, 2003, 4:26pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/1 "2003-06-02T16:26:00Z")
. . . or Aleve or Motrin? _(Respectively: acetylsalicylic acid, acetaminophen, naproxen, and ibuprofen.)_ **PLEASE NOTE: THIS IS NOT A POLL** Based on the mechanism by which each of these analgesics works (Is it true that no one really knows how aspirin works?), which one works fastest, alleviates the most pain, and lasts the longest? ---
**Author:** ![CookingWithGas](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cookingwithgas/32/485_2.png) [@CookingWithGas](https://boards.straightdope.com/u/CookingWithGas)\ **Post date:** [June 2, 2003, 8:33pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/2 "2003-06-02T20:33:37Z")
Depends on what’s causing the pain. Aspirin and Motrin (Ibuporfen) have the benefit of reducing inflammation, which Tylenol will not do. Different individuals respond to each of these differently, also. ---
**Author:** ![Rob\_V](https://avatars.discourse-cdn.com/v4/letter/r/eb8c5e/32.png) [@Rob\_V](https://boards.straightdope.com/u/Rob_V)\ **Post date:** [June 2, 2003, 8:55pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/3 "2003-06-02T20:55:30Z")
Yeah, what CookingWithGas said. Seems to depend upon the person, and what hurts. For me, aspirin (mainly) or ibuprofen work best for headaches. Tylenol doesn’t seem to do anything for me. Additionally, acetominiphen, I’ve heard, is not good for people with liver issues. I try to stick to aspirin. ---
**Author:** ![asterion](https://avatars.discourse-cdn.com/v4/letter/a/4da419/32.png) [@asterion](https://boards.straightdope.com/u/asterion)\ **Post date:** [June 2, 2003, 10:11pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/4 "2003-06-02T22:11:03Z")
Also, caffeine is used in Excedrin. I believe that is used as a vasodialator to help ease headaches. ---
**Author:** ![irishgirl](https://avatars.discourse-cdn.com/v4/letter/i/8edcca/32.png) [@irishgirl](https://boards.straightdope.com/u/irishgirl)\ **Post date:** [June 2, 2003, 10:30pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/5 "2003-06-02T22:30:02Z")
We know how aspirin works. It’s a cyclo-oxygenase inhibitor, which prevents the formation of inflammatory mediators such as cytokines. Cytokines and other inflammatory mediators sensitise neurons to pain, and cause inflammation. All NSAIDS work in a similar manner, some having stronger analgaesic effects, and some having stronger anti-inflammatory ones. So, basically it depends on the cause of the pain, if it’s from inflamed sinuses, I’d take aspirin or ibuprofen, if it’s a hangover, paracetamol (acetominophen). For migraine, ergotamine derivatives and an anti-emetic. For moderate pain, ibuprofen plus a central analgaesic like codeine is probably ---
**Author:** ![irishgirl](https://avatars.discourse-cdn.com/v4/letter/i/8edcca/32.png) [@irishgirl](https://boards.straightdope.com/u/irishgirl)\ **Post date:** [June 2, 2003, 10:32pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/6 "2003-06-02T22:32:30Z")
argh… Is probably the most effective option. ---
**Author:** ![eutactic](https://avatars.discourse-cdn.com/v4/letter/e/22d042/32.png) [@eutactic](https://boards.straightdope.com/u/eutactic)\ **Post date:** [June 2, 2003, 10:44pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/7 "2003-06-02T22:44:38Z")
Personally, I find Advil to be a miracle worker. It, too, is ibuprofen (I think!). Anyway, Tylenol never works for me, but pop a couple Advil and within 30 minutes, the headache is completely gone. Brilliant, brilliant little pill. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 2, 2003, 10:44pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/8 "2003-06-02T22:44:45Z")
People! NSAIDS take time to reduce inflammation. One must take ibuprofen (motrin, etc.) at least 3 times a day for a few weeks to appreciate the anti-inflammatory effect. It does however reduce pain quickly after one dose. Whether it reduces it better than acetaminophen (tylenol or APAP) is a very individualistic thing. BTW: Caffiene is a vaso-constrictor, not a vasodilator. And watch the codiene here in the states. It’s a Controlled Substance, and unauthorized use can put you in trouble. QtM, MD ---
**Author:** ![irishgirl](https://avatars.discourse-cdn.com/v4/letter/i/8edcca/32.png) [@irishgirl](https://boards.straightdope.com/u/irishgirl)\ **Post date:** [June 2, 2003, 11:48pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/9 "2003-06-02T23:48:56Z")
Sorry. QTM you’re right, but codeine plus ibuprofen is an OTC medication here, which I am very grateful for as it knocks my cramps down from agonising to bearable. ---
**Author:** ![lillyflower](https://avatars.discourse-cdn.com/v4/letter/l/49beb7/32.png) [@lillyflower](https://boards.straightdope.com/u/lillyflower)\ **Post date:** [June 2, 2003, 11:54pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/10 "2003-06-02T23:54:02Z")
I get pretty bad headachs and aI would have to say that Aleve works best for those and works the best for me for cramps. now, if I have just minor pain then I usually take advil 🙂 ---
**Author:** ![juji\_mojo](https://avatars.discourse-cdn.com/v4/letter/j/7ea924/32.png) [@juji\_mojo](https://boards.straightdope.com/u/juji_mojo)\ **Post date:** [June 2, 2003, 11:59pm UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/11 "2003-06-02T23:59:10Z")
My two cents. (What do RN’s know anyway, we just give the stuff and see how it work, then bug the doctor when it doesn’t…) Acetaminophen is prescribed the most for general pain relief, unless there is some obvious inflammatory process (arthritis, for example) a doctor will just increase the doseage or add codine to the mix ( Tylenol #3) But NSAIDS like asprin, ibuprofen, naprosyn, etc are effective anti inflammatories that in some people and some cases are much more effective. Depends on the person and the cause. I would never take Tylenol for menstrual pains, naproxyn (Aleve) is much more effective. When I had no Aleve and I had an abcessing tooth, I took Ibuprofen alternating with Tylenol #3(by prescription) and the combination worked better than either alone. Of course with Tylenol you get the liver cautions, and with the NSAIDs you get the gastric upset/potential for bleeding. So no real answer, just anecdote. Sorry. ---
**Author:** ![Markxxx](https://avatars.discourse-cdn.com/v4/letter/m/5daacb/32.png) [@Markxxx](https://boards.straightdope.com/u/Markxxx)\ **Post date:** [June 3, 2003, 12:44am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/12 "2003-06-03T00:44:18Z")
Out of curiosity are there any NSAIDs that are prescription. I ask cause I took Orudis and it NEVER worked. When I pulled my calf I took a prescription dose and WOW it worked so quick so fast and effective. I had tooth pulled and my dentist told me to take 4 ibuprophen and it was OK but I took my Orudis at prescription and boom knocked it out. I noticed at the recommended dosage 1 pill it does nothing. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 3, 2003, 1:26am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/13 "2003-06-03T01:26:50Z")
In the US, many NSAIDS are prescription only, and some are non-prescription when taken in recommended doses, such as naproxen, ibuproven, and ketoprofen. BTW, the OTC recommended doses generally are NOT anti-inflammatory doses. Higher doses (in one pill) are available by prescription for these. The prescription only ones (and I may be wrong, I frequently am) include sulindac, toradol, diclofenac, vioxx, celebrex, and indocin among others. And if aspirin came out today, it would probably not pass FDA muster, as its side-effect profile (for anti-inflammatory doses) is much higher than most others. ---
**Author:** ![alice\_in\_wonderland](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alice_in_wonderland/32/176_2.png) [@alice\_in\_wonderland](https://boards.straightdope.com/u/alice_in_wonderland)\ **Post date:** [June 3, 2003, 2:51am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/14 "2003-06-03T02:51:58Z")
> [@](#): > > \*Originally posted by irishgirl \* > \*\* if it’s a hangover, paracetamol (acetominophen). > \*\* EEK! :eek: There is some fairly compelling evidence that taking Tylenol (paracetamol), even **ONCE** after a lot of drinking is enough to cause some pretty serious liver damage in some people. Docs here advise strongly _AGAINST_ Tylenol as a cure for a hangover for exactly this reason. I’m sure I can find a cite somewhere - the research is fairly recent, but it was certainly compelling enough for a number of advisories to be issued. Just as FYI. ---
**Author:** ![alice\_in\_wonderland](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alice_in_wonderland/32/176_2.png) [@alice\_in\_wonderland](https://boards.straightdope.com/u/alice_in_wonderland)\ **Post date:** [June 3, 2003, 2:52am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/15 "2003-06-03T02:52:20Z")
> [@](#): > > \*Originally posted by irishgirl \* > \*\* if it’s a hangover, paracetamol (acetominophen). > \*\* EEK! :eek: There is some fairly compelling evidence that taking Tylenol (paracetamol), even **ONCE** after a lot of drinking is enough to cause some pretty serious liver damage in some people - as in liver failure. As in you need a transplant. Docs here advise strongly _AGAINST_ Tylenol as a cure for a hangover for exactly this reason. I’m sure I can find a cite somewhere - the research is fairly recent, but it was certainly compelling enough for a number of advisories to be issued. Just as FYI. ---
**Author:** ![alice\_in\_wonderland](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alice_in_wonderland/32/176_2.png) [@alice\_in\_wonderland](https://boards.straightdope.com/u/alice_in_wonderland)\ **Post date:** [June 3, 2003, 3:19am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/16 "2003-06-03T03:19:47Z")
Here we go: Authors Draganov P. Durrence H. Cox C. Reuben A., Alcohol-acetaminophen syndrome. Even moderate social drinkers are at risk. Postgraduate Medicine. 107(1):189-95, 2000 Jan. > [@](#): > > **Abstract** > In long-term alcohol users, the syndrome of hepatotoxicity from acetaminophen taken in therapeutic or modestly excessive doses is distinctive. It is characterized by striking elevation of transaminase levels and the potential for acute liver failure with high morbidity and mortality rates. A high index of suspicion should be maintained; in any patient with evidence of acute hepatic injury, a complete history of over-the-counter drug use should be obtained and acetaminophen levels checked. If there is doubt about the dose or time of ingestion, one should err on the side of treatment with acetylcysteine, because it is both effective and safe. Therapy should be initiated as early as possible, but even late administration may be of benefit. Timely contact with a medical center that has liver transplantation capabilities should be made before encephalopathy becomes advanced. Heightened awareness of this preventable and treatable condition is needed by healthcare providers and acetaminophen users alike. _Because the minimum safe dose of acetaminophen is not known in the setting of chronic alcohol use, it seems prudent in such situations to avoid acetaminophen altogether, especially during brief periods of abstinence._ Schiodt FV. Lee WM. Bondesen S. Ott P. Christensen E. Influence of acute and chronic alcohol intake on the clinical course and outcome in acetaminophen overdose. Alimentary Pharmacology & Therapeutics. 16(4):707-15, 2002 Apr. > [@](#): > > **Abstract** > BACKGROUND: Animal studies on acetaminophen toxicity suggest that chronic alcohol intake affects the outcome adversely, whereas acute alcohol intake seems protective. Few clinical data are available. METHODS: We studied 209 consecutive patients with single-dose acetaminophen overdose. The combined influence of independent variables (gender, age, dose, delay to antidote treatment, chronic and acute alcohol intake and nomogram risk group) on dependent variables (death, development of hepatic encephalopathy and biochemical liver markers) was studied using multiple or logistic regression analysis. RESULTS: Fifty-seven (27.3%) patients had chronic alcohol intake and 45 (21.5%) patients had acute alcohol intake. Forty-four (21.1%) patients developed hepatic coma and 20 (43.5%) of these patients died. _Chronic alcohol intake was significantly and independently associated with the development of hepatic coma, with a lower prothrombin index, lower platelet count, higher creatinine and higher bilirubin._ The relative risks for hepatic coma and death were 5.3 (95% confidence interval, 2.2-12.4) and 1.4 (95% confidence interval, 0.5-3.9), respectively, in the chronic alcohol intake group compared with the no chronic alcohol intake group. Acute alcohol intake was not significantly associated with any of the dependent variables studied. CONCLUSIONS: Chronic alcohol intake enhances acetaminophen hepatotoxicity, whereas acute alcohol intake does not affect the clinical course. Agarwal R. Farber MO.Is continuous veno-venous hemofiltration for acetaminophen-induced acute liver and renal failure worthwhile?.Clinical Nephrology. 57(2):167-70, 2002 Feb. > [@](#): > > **Abstract** > > We describe a patient with acute liver and renal failure secondary to acetaminophen and chronic alcohol abuse who was treated aggressively with oral acetylcysteine, continuous renal replacement therapy, glucose and branched-chain amino acid intravenous feeding and ventilatory support. The patient had a predicted mortality of \> 95% without liver transplantation however, with intensive ventilatory, renal, and nutritional support he made a complete recovery. We discuss the benefits of aggressive supportive therapy and suggest that continuous renal replacement therapy may allow gentle fluid removal, excellent control of cerebral edema and intravenous feeding that may favorably influence prognosis. So, from a quick glance at Medline, it looks like those folks that drink on a regular basis should avoid Tylenol for a hang-over, and those that drink occasionally should perhaps avoid it for a hang-over too. ---
**Author:** ![Apoptosis](https://avatars.discourse-cdn.com/v4/letter/a/ba9def/32.png) [@Apoptosis](https://boards.straightdope.com/u/Apoptosis)\ **Post date:** [June 3, 2003, 5:48am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/17 "2003-06-03T05:48:39Z")
Hey all, I’ve been lurking here for several years & finally decided to post. While I can’t answer the OP, there are a few subsequent points that should be cleared up. > [@](#): > > Is it true that no one really knows how aspirin works? In the late 70s, Sir John Vane (Nobel Prize in Medicine, 1982) discovered that aspirin attenuated inflammation via the inhibition of cyclooxygenase (COX). To date, three isoforms of COX have been identified (COX1, COX2, and COX3). Aspirin inhibits both COX1 and COX2 (as does ibuprofen, but via a totally different mechanism). Unfortunately, while this has anti-inflammatory effects, it is also responsible for the gastrointestinal problems (e.g. gastric erosions) associated with NSAIDS. The mechanism of action of acetaminophen, on the other hand, is not well understood. It is believed that it may inhibit COX3, which seems to be selectively expressed in the brain. > [@](#): > > We know how aspirin works. It’s a cyclo-oxygenase inhibitor, which prevents the formation of inflammatory mediators such as cytokines. This is a little misleading. Cyclooxygenases catalyze the formation of prostaglandin H2 (PGH2), which can then be used as a substrate to produce various other prostaglandins and thromboxanes. And yes, the inhibition of COX1 and COX2 can lead to the inhibition of various cytokines. However, this is a gross oversimplification of what’s going on. Whether a given prostaglandin or cytokine (and there’s LOTS of them) acts in an anti- or pro-inflammatory manner is dependent on its concentration, location, the cell type secreting it, and a whole host of other factors. > [@](#): > > All NSAIDS work in a similar manner. This is sort of true. However, the new players in the field, Celebrex and Vioxx, are selective COX2 inhibitors. The thinking is that, because COX1 is constitutively expressed while COX2 is upregulated during inflammation, that inhibiting COX2 but not COX1 will attenuate inflammation while sparing the GI tract. Of course, things are not nearly as simple as that. Pfizer covered up the fact that Celebrex does not differ from conventional NSAIDs in its GI toxicity. Merck covered up the fact that Vioxx can cause serious thrombotic events. But hey- whatever makes a buck. Sorry for this long-winded post, but it’s an area in which I’m interested. Bottom line: inflammation is your body’s way of trying to deal with a problem. If the problem is as simple as a headache, I suggest you stay away from NSAIDs entirely. Works for me. -Apoptosis Here are a few links (although I would really recommend looking for papers by J Vane or J Wallace on PubMed): Basic stuff- [http://www.nsaid.net/](http://www.nsaid.net/) Pfizer lies (scroll down a couple pages)- [http://www.who.int/medicines/library/pnewslet/3news2002.pdf](http://www.who.int/medicines/library/pnewslet/3news2002.pdf) Merck lies (page 13)- [http://www.who.int/druginformation/vol16num1\_2002/vol16-1.pdf](http://www.who.int/druginformation/vol16num1_2002/vol16-1.pdf) ---
**Author:** ![Apoptosis](https://avatars.discourse-cdn.com/v4/letter/a/ba9def/32.png) [@Apoptosis](https://boards.straightdope.com/u/Apoptosis)\ **Post date:** [June 3, 2003, 6:05am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/18 "2003-06-03T06:05:07Z")
Sorry to post again, but I just noticed this: > [@](#): > > And if aspirin came out today, it would probably not pass FDA muster, as its side-effect profile (for anti-inflammatory doses) is much higher than most others. Heh heh- it’s great to see our doctors have such faith in the FDA. Celebrex and Vioxx were approved VERY quickly and are doing damn well for themselves. Too bad their safety profiles are no better (and are probably actually worse) than that of aspirin. Here’s a decent cite- > **[Should You Take Celebrex for Your Arthritis?](https://www.verywellhealth.com/celebrex-celecoxib-2552186)** > > Celebrex, generic name celecoxib, is a COX-2 inhibitor/selective NSAID used to treat arthritis. Learn about use, dosage, overdose and side effects. -Apoptosis ---
**Author:** ![MaryEFoo](https://avatars.discourse-cdn.com/v4/letter/m/ba8739/32.png) [@MaryEFoo](https://boards.straightdope.com/u/MaryEFoo)\ **Post date:** [June 3, 2003, 6:16am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/19 "2003-06-03T06:16:59Z")
Interesting thread. For someone with limitations on these drugs, what would be a solution? Aspirin and ibuprofin (Advil) give me gastro-intestinal problems, and I had infectious hepatitis (hep-B IIR) after a stay in Mexico. Aleve is recommended for not oftener than once in 12 hours. Is it an NSAID? I use acetaminophen, or caffeine, or sugar, for headaches. I would like to use low-dose aspirin for heart health, and because it may fend off Alzheimer’s. Any helpful comments? or should I ask my doc on the next appointment–probably wise to warn in advance I will ask this question. Footnote: my GI gastric reflux/soreness/hiccups cleared somewhat upon avoiding caffeine, but results were quicker and better with sipping cool water throughout the day for about five days–the idea being to cool off the stomach and reduce its irritation and secreting of acids. Free home remedy FYI. ---
**Author:** ![Apoptosis](https://avatars.discourse-cdn.com/v4/letter/a/ba9def/32.png) [@Apoptosis](https://boards.straightdope.com/u/Apoptosis)\ **Post date:** [June 3, 2003, 7:07am UTC](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154/20 "2003-06-03T07:07:19Z")
Hi MaryEFoo! I am not a physician- this is definitely an area you should ask him/her about. Having said that, here’s some info: Aleve contains the NSAID naproxen, which was actually used as a control drug during the Vioxx trials. As naproxen inhibits COX1 and COX2, it can lead to gastric ulceration (just as ibuprofen and aspirin can). It’s good to hear you’ve kept the reflux under control. However, please remember that drinking cool water is not going to prevent gastric erosions! Finally, low-dose aspirin does indeed possess cardioprotective properties. However, patients already taking COX2 inhibitors (e.g. Celebrex) should be VERY cautious about concurrent low-dose aspirin. Please talk to your doctor about this, as the synergistic gastric toxicity is disturbing (see my WHO links above). I should probably mention at this point that I have no personal vendetta against NSAIDs. They are extremely important in managing pain caused by various inflammatory conditions. However, as with all drugs, the drawbacks need to be measured against the benefits. For instance, an arthritis patient considering switching from a conventional NSAID to Vioxx has to ask themselves this: “what would I rather deal with: gastric ulcers or myocardial infarction?” -Apoptosis [Next page](https://boards.straightdope.com/t/which-works-better-on-headaches-aspirin-or-tylenol/179154.md?page=2)