Painkiller for Headache: Paracetamol, Ibuprofen and Aspirin Compared
Your head is pounding, you are standing in front of the pharmacy shelf (or your bathroom cabinet), and you are wondering which painkiller for headache is the right one. Paracetamol, ibuprofen, aspirin: they all say "headache" on the box, so what is actually different?
Short answer: they work in different ways, they come with different precautions, and none of them is meant to be used every few days. This article explains the main differences in plain language, without doses, so you can have a more informed chat with your pharmacist or doctor. For the bigger picture, you can also have a look at our guide to migraine treatments.
A quick note on names: paracetamol is called acetaminophen in the US (Tylenol is a brand), and ibuprofen is sold as Advil, Motrin or Nurofen depending on where you live.
In short
- Paracetamol (acetaminophen) is the gentlest on the stomach, but it does not reduce inflammation, and two different products containing it can add up to an overdose.
- Ibuprofen and aspirin are anti-inflammatory painkillers (NSAIDs): they are often effective for headaches and migraine, but they are not suitable for everyone, for example people with a stomach ulcer.
- Taking headache painkillers on 10 to 15 days a month or more can cause medication overuse headache, which means more headaches, not fewer.
- If you reach for painkillers often, or they stop working, talk to a pharmacist or doctor rather than adjusting things on your own.
What are the main painkillers you can buy for a headache?
Most over-the-counter options fall into three groups: paracetamol, anti-inflammatory painkillers (ibuprofen, aspirin, naproxen) and combination products that add caffeine. For episodic tension headaches, the Cleveland Clinic lists acetaminophen, aspirin, ibuprofen and naproxen as the usual over-the-counter choices.
For migraine, the picture is similar. The American Migraine Foundation says OTC medicines range from single-ingredient products like aspirin, acetaminophen, ibuprofen or naproxen sodium to combination medicines such as Excedrin Migraine.
What changes from one to the other is how they work, what they are gentle or harsh on, and who should avoid them. That is what the next sections cover. If you want a wider overview that also includes prescription options, see Migraine Medication: Painkillers, NSAIDs and Triptans Explained.
Paracetamol: the gentlest option, but not the strongest
Paracetamol is often the first thing people reach for because it tends to be easy on the stomach. The Cleveland Clinic notes that, unlike NSAIDs, acetaminophen does not reduce inflammation, but it doesn't cause as many gastrointestinal issues, so it can be a better fit if your stomach is sensitive.
The NHS describes it as a painkiller that can be used for headaches, toothache, sore throat and cold or flu symptoms. It may not be suitable if you have a liver or kidney condition, or if you are dependent on alcohol or binge drink.
The main trap is hidden paracetamol. It is also found in many cold and flu remedies and in some combination painkillers, and the NHS warns that taking two different medicines that contain paracetamol risks an overdose. Always read the ingredient list, especially when you have a cold and a headache at the same time.
As for how well it works, a systematic review and network meta-analysis of episodic tension-type headache compared paracetamol and ibuprofen directly and found no difference in the share of people who were pain-free at two hours. For migraine, some people respond better to anti-inflammatories, and responses vary from person to person.
Ibuprofen and other anti-inflammatories: often effective, more precautions
Ibuprofen is a painkiller that also treats inflammation, and it is a common choice for both tension headache and migraine. The American Migraine Foundation says some people find NSAIDs consistently effective, even for moderate to severe migraine. Ibuprofen and naproxen are the best-known examples.
The trade-off is the stomach. The NHS explains that ibuprofen can cause ulcers in your stomach or gut, especially if it is taken for a long time or in big amounts. It is not suitable if you have a stomach ulcer or have had one before.
Asthma is another thing to know about. The NHS says some people with asthma may not be able to take anti-inflammatory painkillers, and that if you have asthma you should not take ibuprofen unless you have taken it or similar products before.
Because these details depend on your own health history, a pharmacist is the right person to ask. It takes two minutes at the counter and saves a lot of guesswork.
Aspirin: an anti-inflammatory with its own rules
Aspirin works in a similar way to ibuprofen, and it has a few special rules of its own. The NHS explains that aspirin stops your body making prostaglandins, substances involved in pain, swelling and fever. The same page says aspirin may work better than paracetamol for period pain or migraine.
Like ibuprofen, it can irritate the stomach: the NHS says aspirin can cause ulcers in your stomach or gut, and if you are at risk of one, paracetamol is gentler on your stomach.
The most important rule is about age. The NHS says aspirin should never be given to children under 16 unless a doctor prescribes it, because it can make them more likely to develop Reye's syndrome, which is very rare but can cause serious liver and brain damage. If your teenager has headaches, our article on migraine in children and teens is a good place to start, and a pharmacist can guide you on what is suitable for their age.
Tension headache or migraine: does the choice change?
Largely, the same over-the-counter painkillers are used for both, but timing and expectations are a bit different. For tension headaches, the options above are the usual ones, and the Cleveland Clinic suggests limiting pain relievers to 10 days in any given month. If you are not sure which type you have, Migraine vs Headache: What's the Difference? and Tension Headache Symptoms can help you see the pattern.
For migraine, timing matters. The NHS advises that if you take painkillers, you should take them as soon as the headache starts. The American Migraine Foundation also stresses that acute treatments work best when taken quickly.
Migraine also brings nausea and a slowed-down stomach for some people, and it is common to find that a painkiller that works for a tension headache does little for a full migraine attack. That does not mean you did anything wrong. It may simply mean it is time to talk to your doctor about other options, such as triptans, which are migraine-specific medicines prescribed by a doctor.
The American Migraine Foundation also notes that not all medications work the same for every individual. Finding what suits you is a personal process that is best done with a healthcare professional.
Can you combine or alternate painkillers?
Some combinations are common, but whether they are right for you is a question for a pharmacist or doctor. The NHS says adults can take paracetamol at the same time as ibuprofen if needed, but suggests trying them on their own first to see if they help.
Many products also bundle ingredients for you. The American Migraine Foundation gives the example of acetaminophen, aspirin and caffeine in a single tablet, and notes that caffeine is sometimes included to help the body absorb the other medicines.
Combination products come with a catch. The foundation warns that painkillers combining caffeine, aspirin and acetaminophen can cause medication overuse headache when used 10 or more days per month, and that caffeine-containing medicines seem especially likely to do so.
The practical point: if you combine or alternate, it is easy to lose track of how many days you are taking something. Counting every day you take any headache medicine, whatever the brand, is what matters.
How often is too often? Painkillers and rebound headaches
Taking painkillers too often can make headaches more frequent, a problem called medication overuse headache (or rebound headache). The Cleveland Clinic describes it as headaches that happen when you treat headaches with medication too often, causing more headaches, which can be even worse.
Guidance on "how often" differs a little between organisations, which is itself a sign that there is no magic number:
- The NHS says to try not to take painkillers for more than 2 days a week, as this can cause more headaches and make migraine harder to treat.
- The Cleveland Clinic suggests limiting over-the-counter headache medicines to two days or fewer per week.
- Mayo Clinic says medication overuse headaches may occur if you take aspirin or ibuprofen for more than 14 days a month.
- The American Migraine Foundation says most NSAIDs can lead to medication overuse headache if used more than 10 to 15 days per month.
The pattern is clear enough: occasional use is fine, regular use is the risk. Mayo Clinic adds that these headaches often wake people from sleep, and that they most often go away after stopping the pain medicine. Stopping can be uncomfortable, so it is best done with a doctor's guidance rather than all at once on your own.
If this sounds familiar, our article Why Do I Have a Headache Every Day? explains the other possible causes of near-daily headaches, and Migraine Diary: What to Write Down shows how to track what is going on.
When should you ask a pharmacist or doctor?
Ask a pharmacist before buying if you are unsure what is safe for you, and see a doctor if painkillers are becoming a regular habit. A pharmacist can check your medicines, your health history (stomach problems, asthma, liver or kidney conditions) and the ingredient lists of anything you already take.
It is a good moment to book a doctor's appointment if:
- you need painkillers on more days than feels comfortable, or more than about two days a week;
- the painkillers you used to rely on no longer help;
- your headaches are changing, getting more frequent or feel different from usual;
- you take several different products and are not sure what they add up to.
When to See a Doctor for Migraine: Who to Book and How to Prepare walks you through what to bring and what to ask. And if a headache is sudden, severe or unlike anything you have had before, see When to Go to the ER for a Migraine for the warning signs.
In short: how to choose without getting it wrong
There is no single best painkiller for headache, only the one that suits your body, your type of headache and your health history. A few simple habits make the choice easier:
- Read the ingredients so you never double up on paracetamol or on anti-inflammatories.
- Check with a pharmacist if you have stomach problems, asthma, or a liver or kidney condition.
- Treat early during a migraine, rather than waiting for the pain to peak.
- Keep painkillers occasional, and count the days you use them.
- Talk to a doctor if you need them often. There are other approaches, including ways to relieve a migraine without medication and, for frequent attacks, preventive treatments your doctor can discuss with you.
None of this is a reason to feel guilty about taking a painkiller when you need one. It is simply about making them work for you, without letting them become part of the problem.
Frequently asked questions
Which painkiller is best for a headache?
There is no single best one. For tension-type headache, a network meta-analysis found no difference between paracetamol and ibuprofen in pain-free rates at two hours, so the choice often depends on which one suits your stomach and health history. A pharmacist can help you choose.
Is paracetamol or ibuprofen better for a migraine?
Both are listed as options, and the response varies from person to person. The American Migraine Foundation says some people find NSAIDs like ibuprofen consistently effective, even for moderate to severe migraine, while paracetamol is gentler on the stomach. If neither helps, your doctor may discuss other treatments.
Can painkillers cause headaches?
Yes, if they are used too often. The Cleveland Clinic explains that treating headaches with medication too often can cause more headaches, known as rebound headaches. Keeping use occasional and talking to a doctor if you need them regularly is the safest approach.
Can I take aspirin for a headache if I am under 16?
No. The NHS says children under 16 should not be given aspirin unless a doctor prescribes it, because of the risk of Reye's syndrome. Ask a pharmacist or doctor which painkiller is suitable for a child or teenager.
How do I know if my painkillers are not working anymore?
Sources
- Paracetamol for adults: painkiller for pain and high temperature - NHS
- Ibuprofen for adults: painkiller that also treats inflammation - NHS
- Who can and cannot take or use ibuprofen - NHS
- Aspirin: medicine for pain relief or preventing blood clots
- Reye's syndrome - NHS
- Migraine - NHS
- Medication overuse headaches - Symptoms and causes - Mayo Clinic
- Take a pass on rebound headaches and steal your life back
- Tension Headache: Symptoms & How To Relieve
- NSAIDs for Migraine
- OTC Migraine Medication
- Which Pain Medications Work Best for Migraine?
- What Is Medication Overuse Headache?
- Paracetamol versus ibuprofen in treating episodic tension-type headache: a systematic review and network meta-analysis
Written by Laurine Nicoletti, founder of Mellow, who has lived with migraine since she was 21. Learn more · How we write our articles
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