question: For a headache, could it more effective to take a combination of aspirin, acetaminophen, ibuprofen, and/or naproxen, OR is it more effective to take a dose of just one of these painkillers?
comment: Aspirin, ibuprofen, and naproxen are all NSAID pain relievers that have similar mechanisms of action. DO NOT COMBINE THESE DRUGS. Choose one of them and then you can combine it with acetaminophen, which is a different type of medication. An NSAID pain reliever combined with acetaminophen is very effective at relieving pain and is a safe combination. SOURCE: i worked at a pharmacy for 3 years
passages: The other primarily recommended treatment of acute attacks is subcutaneous or intranasal sumatriptan. Sumatriptan and zolmitriptan have both been shown to improve symptoms during an attack with sumatriptan being superior. Because of the vasoconstrictive side-effect of triptans, they may be contraindicated in people with ischemic heart disease.
  
  Section::::Management.:Opioids.
  
  The use of opioid medication in management of CH is not recommended and may make headache syndromes worse. Long-term opioid use is associated with well known dependency, addiction, and withdrawal syndromes. Prescription of opioid medication may additionally lead to further delay in differential diagnosis, undertreatment, and mismanagement.
  
  Section::::Management.:Other.
   Over-the-counter drugs, like acetaminophen, aspirin, or NSAIDs(ibuprofen, Naproxen, Ketoprofen), can be effective but tend to only be helpful as a treatment for a few times in a week at most. For those with gastrointestinal problems (ulcers and bleeding) acetaminophen is the better choice over aspirin, however both provide roughly equivalent pain relief. It is important to note that large daily doses of acetaminophen should be avoided as it may cause liver damage especially in those that consume 3 or more drinks/day and those with pre-existing liver disease. Ibuprofen, one of the NSAIDs listed above, is a common choice for pain relief but may also lead to gastrointestinal discomfort.
   Intravenous metoclopramide or intranasal lidocaine are other potential options. Metoclopramide is the recommended treatment for those who present to the emergency department. A single dose of intravenous dexamethasone, when added to standard treatment of a migraine attack, is associated with a 26% decrease in headache recurrence in the following 72 hours. Spinal manipulation for treating an ongoing migraine headache is not supported by evidence. It is recommended that opioids and barbiturates not be used.
   Section::::Causes.:Headache treatment.
  
  Opioids and butalbital are sometimes inappropriately used as treatment for migraine and headache and should be avoided in favor of more effective, migraine-specific treatments. Opioid and butalbital use can worsen headaches and cause MOH. When a patient fails to respond to other treatment or migraine specific treatment is unavailable, then opioids may be used.
   Initial recommended treatment is with simple pain medication such as ibuprofen and paracetamol (acetaminophen) for the headache, medication for the nausea, and the avoidance of triggers. Specific medications such as triptans or ergotamines may be used in those for whom simple pain medications are not effective. Caffeine may be added to the above. A number of medications are useful to prevent attacks including metoprolol, valproate, and topiramate.
   Drug withdrawal is performed very differently within and across countries. Most physicians prefer inpatients programmes, however effective drug withdrawal may also be achieved in an outpatient setting in uncomplicated MOH patients (i.e. subjects without important co-morbidities, not overusing opioids or ergotaminics and who are at their first detoxification attempt). In the absence of evidence-based indications, in MOH patients the choice of preventive agent should be based on the primary headache type (migraine or TTH), on the drug side-effect profile, on the presence of co-morbid and co-existent conditions, on patient’s preferences, and on previous therapeutic experiences.
   Migraine can be somewhat improved by lifestyle changes, but most people require medicines to control their symptoms. Medications are either to prevent getting migraines, or to reduce symptoms once a migraine starts.
  
  Preventive medications are generally recommended when people have more than four attacks of migraine per month, headaches last longer than 12 hours or the headaches are very disabling. Possible therapies include beta blockers, antidepressants, anticonvulsants and NSAIDs. The type of preventive medicine is usually chosen based on the other symptoms the person has. For example, if the person also has depression, an antidepressant is a good choice.
   Intravenous metoclopramide, intravenous prochlorperazine, or intranasal lidocaine are other potential options. Metoclopramide or prochlorperazine are the recommended treatment for those who present to the emergency department. Haloperidol may also be useful in this group. A single dose of intravenous dexamethasone, when added to standard treatment of a migraine attack, is associated with a 26% decrease in headache recurrence in the following 72 hours. Spinal manipulation for treating an ongoing migraine headache is not supported by evidence. It is recommended that opioids and barbiturates not be used due to questionable efficacy, addictive potential, and the risk of rebound headache.
  
  Section::::Management.:Children.
   Abortive therapies for migraines may be oral, if the migraine is mild to moderate, or may require stronger medicine given intravenously or intramuscularly. Mild to moderate headaches should first be treated with acetaminophen (paracetamol) or NSAIDs, like ibuprofen. If accompanied by nausea or vomiting, an antiemetic such as metoclopramide (Reglan) can be given orally or rectally. Moderate to severe attacks should be treated first with an oral triptan, a medication which mimics serotonin (an agonist) and causes mild vasoconstriction. If accompanied by nausea and vomiting, parenteral (through a needle in the skin) triptans and antiemetics can be given.
   Section::::Medicinal.:Preventative medications.
  
  The most common medicines used to treat chronic (daily) headaches are called prophylactic medicines, which are used to prevent headaches. Such preventative medication is taken on a daily basis, even when a person may not have a headache. Prophylactic medicines are recommended for chronic headache patients because varied experiments prove that the medications "reduce the frequency, severity, and disability associated with daily headaches". A majority of the prophylactic medications work by inhibiting or increasing neurotransmissions in the brain, often preventing the brain from interpreting pain signals.
   Aspirin, either by itself or in a combined formulation, effectively treats certain types of a headache, but its efficacy may be questionable for others. Secondary headaches, meaning those caused by another disorder or trauma, should be promptly treated by a medical provider.
  
  Among primary headaches, the International Classification of Headache Disorders distinguishes between tension headache (the most common), migraine, and cluster headache. Aspirin or other over-the-counter analgesics are widely recognized as effective for the treatment of tension headache.
   BULLET::::- 2003: Excedrin Tension Headache contains 500 mg acetaminophen and 65 mg caffeine.
  
  BULLET::::- 2005: Excedrin Sinus Headache contains 325 mg acetaminophen and 5 mg phenylephrine HCl as a decongestant.
  
  BULLET::::- 2007: Excedrin Back and Body – a dual-ingredient formula claiming that it "works two ways—as a pain reliever and a pain blocker right where it hurts". Contains 250 mg acetaminophen, 250 mg aspirin.
   Preventative medicines include gabapentin (Neurontin), tizanidine (Zanaflex), fluoxetine (Prozac), amitriptyline (Elavil), and topiramate (Topamax). In testing, gabapentin was found to reduce the number of headache days a month by 9.1%. Tizanidine was found to decrease the average frequency of headaches per week, the headache intensity, and the mean headache duration. Through studies, Fluoxetine resulted in better mood ratings and "significant increases in headache-free days". Despite being associated with depression, antidepressants, such as amitriptyline, have been found to effectively treat "near-daily headaches" and numerous chronic pain conditions as well as improving mood and sleep—two possible triggers for chronic headache sufferers. One study found that the headache frequency over a 28-day period lowered for chronic headache patients on topiramate. Another medication to prevent headaches is botulinum toxin type A (BoNTA or BOTOX), which is given by injection instead of being taken orally. In a clinical study of botulinum toxin type A, patients participating in the 9-month treatment period with three treatments experienced headache frequency decreases up to 50%. As with all medications, the preventative medications may have side effects. Since different people respond to drugs differently, chronic headache sufferers may have to go through a "trial-and-error" period to find the right medications. The previously mentioned medicines can improve headaches, but physicians recommend multiple forms of treatments.
   Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations like Syndol, Mersyndol and Percogesic, analgesic/barbiturate combinations such as Fiorinal). In addition analgesic/caffeine combinations are popular such as the aspirin-caffeine combination (Anacin) or the aspirin, acetaminophen and caffeine combinations (Excedrin Extra-Strength, Excedrin Migraine, and Vanquish). Frequent use (daily or skipping just one day in between use for 7–10 days) of all of the above analgesics may, however, lead to medication overuse headache.
   Cannabis was a standard treatment for migraines from 1874 to 1942. It has been reported to help people through an attack by relieving the nausea and dulling the head pain, as well as possibly preventing the headache completely when used as soon as possible after the onset of pre-migraine symptoms, such as aura.
  
  BULLET::::- Feverfew
  
  The plant feverfew ("Tanacetum parthenium") is a traditional herbal remedy believed to reduce the frequency of migraine attacks. A number of clinical trials have been carried out to test this claim, but a 2004 review article concluded that the results have been contradictory and inconclusive.
   The two main methods of rescue treatment are trigger avoidance, and acute symptomatic control with medication. Medications are more effective if used earlier in an attack. A serious potential problem with the frequent use of medications is the possible development of medication overuse headache, in which the headaches become more severe and more frequent. This may occur with triptans, ergotamines, and analgesics, especially narcotic analgesics.
  
  Section::::Rescue treatment.:Analgesics.
   BULLET::::2. Antibiotic should be given for 5–6 days in cases of suppuration depending upon culture and sensitivity.
  
  BULLET::::3. Oral and local decongestant are given to improve the patency of ostium.
  
  BULLET::::4. Analgesics may be required for post-operative headache.
  
  Section::::Newer techniques.
  
  BULLET::::- Luma Wire Transillumination: This technique has a number of advantages over antral Lavage, such as:
   The most common chronic treatment method is the use of medicine. Many people try to seek pain relief from analgesic medicines (commonly termed pain killers), such as aspirin, acetaminophen, aspirin compounds, ibuprofen, and opioids. The long term use of opioids; however, appears to result in greater harm than benefit. Also, abortive medications can be used to "stop a headache once it has begun"; such drugs include ergotamine (Cafergot), triptans (Imitrex), and prednisone (Deltasone). However, medical professionals advise that abuse of analgesics and abortive medications can actually lead to an increase in headaches. The painkiller medicines help headaches temporarily, but as the "quick fix" wears off, headaches become more re-current and grow in intensity. These "rebound headaches" can actually make the body less responsive to preventive medication. The conditions keep worsening if one takes paracetamol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) for 15 days a month or more. Therefore, analgesic and abortive medications are often advised for headaches that are not chronic in nature.
   Lithium, methysergide, and topiramate are recommended alternative treatments, although there is little evidence supporting the use of topiramate or methysergide. This is also true for tianeptine, melatonin, and ergotamine. Valproate, sumatriptan, and oxygen are not recommended as preventive measures. Botulinum toxin injections have shown limited success. Evidence for baclofen, botulinum toxin, and capsaicin is unclear.
  
  Section::::Management.
   Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. Supervision by a neurologist is advisable. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to "break the headache cycle" and then they can be discontinued.
   Section::::Management.
  
  There are three main aspects of treatment: trigger avoidance, acute symptomatic control, and medication for prevention. Medications are more effective if used earlier in an attack. The frequent use of medications may result in medication overuse headache, in which the headaches become more severe and more frequent. This may occur with triptans, ergotamines, and analgesics, especially opioid analgesics. Due to these concerns simple analgesics are recommended to be used less than three days per week at most.
  
  Section::::Management.:Analgesics.
   Abortive therapy for cluster headaches includes subcutaneous sumatriptan (injected under the skin) and triptan nasal sprays. High flow oxygen therapy also helps with relief.
  
  For people with extended periods of cluster headaches, preventive therapy can be necessary. Verapamil is recommended as first line treatment. Lithium can also be useful. For people with shorter bouts, a short course of prednisone (10 days) can be helpful. Ergotamine is useful if given 1–2 hours before an attack. See cluster headaches for more detailed information.
  
  Section::::Management.:Secondary headaches.
   BULLET::::- Aspirin can be taken daily in low doses such as 80 mg. The blood thinners in ASA have been shown to help some migraineurs, especially those who have an aura.
  
  BULLET::::- Placebo is as effective as adding propanolol to patients not adequately controlled on topiramate. In a randomized controlled trial, both groups reduced their days with migraine by half.
  
  BULLET::::- L-cysteine as a slow release formulation is being studied for migraine prevention.
  
  Section::::Medical devices.
  
  Section::::Medical devices.:Transcutaneous electrical nerve stimulation.
   Medications may be prescribed to treat sleep problems and depression. Analgesics such as ibuprofen can be taken for headaches, but paracetamol (acetaminophen) is preferred to minimize the risk of intracranial hemorrhage. Concussed individuals are advised not to use alcohol or other drugs that have not been approved by a doctor as they can impede healing. Activation database-guided EEG biofeedback has been shown to return the memory abilities of the concussed individual to levels better than the control group.
   Phenothiazines, often used for the treatment of nausea and vomiting, are also effective for treating migraine headache. Prochlorperazine is typically used due to a more favorable treatment profile. 
  
  Section::::Rescue treatment.:Other.
  
presuppositions: For a headache, it could it more effective to take a combination of aspirin, acetaminophen, ibuprofen, and/or naproxen. Combining painkillers is more effective.
corrections: Aspirin, ibuprofen, and naproxen are all NSAID pain relievers that have similar mechanisms of action and should not be taken together. Painkillers should only be combined with acetaminophen, since they all have similar mechanisms of action.
raw_presuppositions: For a headache, it could it more effective to take a combination of aspirin, acetaminophen, ibuprofen, and/or naproxen. Combining painkillers is more effective.
raw_corrections: Aspirin, ibuprofen, and naproxen are all NSAID pain relievers that have similar mechanisms of action and should not be taken together. Painkillers should only be combined with acetaminophen, since they all have similar mechanisms of action.