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MEDICATION FOR TREATING HEADACHE: ANALGESICS-ASPIRIN AND ACETAMINOPHEN
Ordinary aspirin is the best and least expensive of the simple analgesics for most painful conditions, including many headaches. In addition to relieving pain, aspirin has these other important properties: the ability to reduce fever, to diminish inflammation, and to lessen blood coagulation. But an overdose of aspirin can be fatal. Adult aspirin tablets contain approximately 325 mg. of acetylsalicylic acid, and the usual adult dose is two tablets taken every four to six hours, as necessary. Aspirin should be avoided or used with caution by patients with certain stomach disorders, like ulcers, or by anyone taking oral antidiabetic preparations or
anticoagulants. Anticoagulants are “blood thinners” and thus reduce the ability of the blood to coagulate. Patients with clotting deficiencies must avoid aspirin.
Aspirin, the “ingredient prescribed most by physicians for pain,” as many commercial advertisers refer to it, is an excellent drug and is recommended for routine pain relief. We do not believe that the more expensive brands of aspirin, including the buffered aspirin, have substantial advantage over the less expensive “house” brands. Buffering, in simple terms, means counteracting the acidity that may play a role in causing the stomach distress associated with aspirin’s use. Sometimes aspirin becomes stale and loses its effectiveness; if your aspirin has a decidedly vinegary taste and smell, it should be discarded for a fresh supply.
An appropriate substitute for aspirin is acetaminophen (Tylenol and Datril). Acetaminophen has analgesic as well as fever-lowering capabilities similar to aspirin. Acetaminophen does not cause some of the side reactions associated with aspirin, but as with other analgesics an abuse can result in liver and kidney abnormalities and even death. An overdose of acetaminophen, particularly in children, may be very serious and more difficult to treat than an overdose of aspirin.
Acetaminophen has the advantage of not irritating the stomach or interfering with anticoagulation therapy, but it lacks aspirin’s anti-inflammatory properties, which make aspirin much more effective in the treatment of some of the pain in arthritic conditions. Acetaminophen tablets usually contain approximately 325 mg. of the drug per tablet, and the average dose is the same as the average dose of aspirin, two tablets every four to six hours.
Let’s look at a sample of over-the-counter nonprescription “combination of ingredient” preparations. Many of these have gained wide popularity. The medications we shall discuss were chosen simply because they are well known and are probably familiar to most readers. These preparations are more expensive than simple aspirin or acetaminophen, and most of them combine aspirin and/ or acetaminophen in various dosages with other less effective analgesics, caffeine, or additional ingredients.
Caffeine is contained in many products used for relief of headache. Caffeine is an extract of plants and seeds from which cola, coffee, cocoa, and tea are derived. Caffeine acts as a mild stimulant and can minimally constrict blood vessels. Caffeine may also assist the absorption of medication from the stomach. These features make caffeine a popular ingredient in headache preparations. But too much caffeine can cause jitteriness, affect heart rate and blood pressure, and even cause headaches, and we feel its liberal use in these preparations is unwarranted.
Empirin remains a popular headache remedy. Until recently this Burroughs Wellcome product contained aspirin, phenacetin, and caffeine, familiar to many, generically, as APC tablets. Phenacetin has now been removed from the formulation because of reports attributing kidney damage to its use. Caffeine has also been deleted because the reasons for its inclusion in a pain remedy require further scientific validation of efficacy and safety. As currently marketed, Empirin contains only aspirin.
Aspirin or acetaminophen may be compounded with codeine in varying amounts (16 mg., 30 mg., 60 mg.). Such combination analgesics may be purchased as inexpensive generic versions or as brand name products. Thus, Empirin #2 tablets contain 16 mg. of codeine, Empirin #3 contains 30 mg. of codeine, and Empirin #4 contains 60 mg. of codeine. Codeine-containing drugs require a physician’s prescription in the United States, but can easily be purchased
“over-the-counter” in Canada, a practice that we think is unwise.
Excedrin contains approximately
250 mg. of aspirin,
250 mg. of acetaminophen, and
65 mg. of caffeine.

The amount of acetaminophen contained in each Excedrin tablet (approximately 250 mg.) is about three-quarters the amount in a plain acetaminophen tablet (325 mg.), and the amount of caffeine (64 mg.) is about one-half that of the caffeine in a cup of coffee. The content of aspirin (approximately 250 mg.) is also about three-quarters of that present in one aspirin (325 mg.). So, in all probability, most people can get about the same amount of pain relief from one and a half ordinary low-cost aspirin tablets as from one Excedrin tablet.
Each Vanquish tablet contains approximately
227 mg. of aspirin,
194 mg. of acetaminophen,
33 mg. of caffeine,
dried aluminum hydroxide gel, and
magnesium hydroxide.
(The latter two are “antacids” used for buffering.)
A Vanquish tablet contains less aspirin than a plain aspirin tablet, much less acetaminophen than one acetaminophen tablet, such as Tylenol, and about the amount of caffeine contained in one-third cup of coffee. You could approximate the analgesic effectiveness of one Vanquish tablet by taking one aspirin tablet, one-half an acetaminophen tablet, and drinking one-third cup of coffee along with an antacid.
An Anacin tablet contains
400 mg. of aspirin, and
32 mg. of caffeine.

One Anacin has the analgesic equivalent of about one and one-third ordinary aspirin tablets and a small amount of caffeine. Anacin is advertised as the “medicine with more of the ingredient that doctors recommend most for pain,” that ingredient being aspirin. The advertisements and promotions also claim that Anacin contains an “extra ingredient” not found in plain aspirin. This extra ingredient, through the process of elimination, must be caffeine, less than one-third the amount of caffeine contained in a cup of coffee. The recommended dose of Anacin is two tablets every four to six hours. The approximate effectiveness of a single Anacin tablet can be achieved by taking one and one-half aspirin and drinking one-third cup of strong coffee.
A summary of these and other over-the-counter nonprescription analgesic preparations has been provided for your convenience in comparing the ingredients and action of these drugs. This table also contains a formula for duplicating, less expensively, these drug combinations, using inexpensive aspirin, acetaminophen, and caffeine (caffeine is not essential to the analgesic effectiveness of these agents or alternatives). If you compare prices between the combination drugs and the simple aspirin and acetaminophen that they contain, and add a little extra cost for some caffeine, we think you will be surprised at how disproportionately expensive many of the combination drugs are. An Anacin tablet, for example, which contains only slightly more aspirin than one aspirin plus caffeine, is approximately four times as expensive as a house-brand aspirin tablet.
*5/88/2*