The only thing more painful than a killer headache or cramps that just won’t quit is the endless array of OTC remedies to choose from—which pain reliever is actually the best pain reliever for your particular issue? Hitting up the drugstore for a pain reliever that’s the cheese to your macaroni can be a tricky business—but don’t worry, we’ve got your (sore) back. Here’s how to figure out the best pain reliever for whatever hurts.
Acetaminophen is best known for relieving headaches, minor aches and pains, and reducing fever. However, it’s not an anti-inflammatory agent, so it won’t reduce swelling and inflammation. Although it’s easier on the stomach than other OTC pain relievers, at very high doses (think: one very large dose or higher than recommended doses over several days) it can cause acute liver failure, according to the Mayo Clinic. Getting your drink on while taking acetaminophen can also lead to liver toxicity, Nicole Van Groningen, M.D., internist at the New York University Langone Medical Center, tells SELF. But there’s usually nothing to worry about, so long as you’re following the instructions on the bottle (and steering clear of the hooch), she adds.
Aspirin is typically used for mild to moderate aches and pains (headaches, pulled muscles), and is also an anti-inflammatory (take that, arthritis!). It’s part of the NSAID family of meds, which work by blocking certain enzymes in the body from making prostaglandins—a hormone-like substance that (among its many talents) alerts you to pain by irritating your nerve endings and triggering inflammation, explains Niket Sonpal, M.D., assistant professor at Touro College of Osteopathic Medicine in New York. Less prostaglandins means less pain and swelling.
“Unlike other NSAIDs, aspirin is considered cardioprotective in patients with certain risk factors by acting as a blood thinner,” says Sonpal. Translation: Smaller chance of heart attack or stroke. However, using NSAIDs on the regular can cause significant side effects, he warns, including gastritis, peptic ulcer disease, and kidney damage. Prostaglandins are also used to protect your stomach lining and help maintain kidney function, so in suppressing them to nix pain, you end up trading one issue for another, he explains.
Ibuprofen (Advil/Motrin) And Naproxen (Aleve)
Ibuprofen and naproxen are also on team NSAID. These pain relievers are famous for putting the kibosh on menstrual cramps, and are excellent in treating joint, muscle, and daily wear and tear pain, says Sonpal. Both options are stronger than aspirin, with naproxen being the strongest pain reliever currently available without a prescription. But with a stronger dose comes an increased risk of side effects. “If you have a history of GI or kidney issues, you should avoid this class entirely,” says Van Groningen. NSAIDs are also not supposed to be mixed with alcohol. It’s always a good idea to check in with your doc before taking OTCs as a safety precaution—especially if you’re pregnant, have allergies, or are taking other medications.
Problem: Joint, Back Or Muscle Pain
Take: Ibuprofen Or Naproxen
Because of the anti-inflammatory effect, an NSAID is typically recommended for acute pain, say from a recent injury or overuse. How much you need to take comes down to swelling and the type of problem that’s occurring. When naproxen is sold over the counter as Aleve, the normal dose is 220 mg. “If you have pain or fever, one Aleve should do it, anything more than that—like gout or arthritis—and you may need higher doses as directed by a physician,” says Sonpal. That’s because the full anti-inflammatory effect doesn’t kick in unless you’re taking doses of around 500 mg of naproxen (or 600 mg of ibuprofen) at a time, says Van Groningen. Sonpal adds that “at low doses, you’re still receiving an anti-inflammatory effect, just not as much.” Always follow the dosage directions on the bottle unless your doctor says otherwise. For severe or ongoing pain that involves swelling, such as arthritis, you should check in with your doc—especially if your joint pain is associated with warmth, redness, or swelling, which could signify an infection that needs urgent treatment.
“Acetaminophen is classically used for fever, and it’s still what I recommend,” says Van Groningen. NSAIDs have the same effect, but acetaminophen is less likely to cause tummy troubles. One caveat: “Be careful taking it if you’re also taking OTC cold and flu medications,” she warns. “These often contain acetaminophen, so if you’re taking max doses of acetaminophen and cold medicine, you could be overdoing it and risking liver damage.”
Problem: Menstrual Cramps
Take: Ibuprofen Or Naproxen
The major cause of menstrual cramps is—surprise, surprise—the release of prostaglandins, which causes the uterus to contract. (In the words of Stephanie Tanner, “How rude!”) “For women with significant menstrual pain and who have predictable periods, I recommend starting ibuprofen or naproxen a day or two before your period starts,” says Van Groningen.
Take: Acetaminophen Or Aspirin
When it comes to which pain reliever works best for headaches, it’s an individual thing—basically, use whichever med gives you better relief, says Van Groningen. But keep in mind they’re only helpful if used a few times a week at most: “If you’re taking these medications more than that, it can (ironically) lead to a medication overuse headache, which only goes away when you stop taking the medication,” she says.
Take: Acetaminophen And Aspirin
“Migraine headaches can be much trickier to treat than garden variety tension headaches,” says Van Groningen, who recommends an acetaminophen/NSAID hybrid, such as Excedrin Migraine. “If you’re concerned that the headache you’re having is a migraine and it’s not responding well to OTC options, there are plenty of prescription medications that can help treat and prevent migraines,” she says. Phew.