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MEDICATION FOR TREATING HEADACHE: ANALGESICS-”SINUS HEADACHE” TABLETS
Much of what has been said about the ordinary headache remedies also applies to many of the so-called “sinus headache” tablets. Most of these drugs combine various combinations of
analgesics, antihistamines, decongestants, and caffeine.
Antihistamines have a number of medicinal properties. Among these are an
“anti-inflammatory” effect, which helps reverse some symptoms of allergic conditions, and a sedative effect. Decongestants are agents that have vasoconstrictive properties and are used in cold and sinus preparations to constrict the blood vessels and membranes of the nose and nasal sinuses.
A Sinarest tablet contains 325 mg. of acetaminophen, 2 mg. of chlorpheniramine maleate (an antihistamine), and 18.75 mg. of phenylpropanolamine (a decongestant). Sine-Off contains 325 mg. of aspirin, 2 mg. of chlorpheniramine maleate (an antihistamine), and 18.75 mg. of phenylpropanolamine (a decongestant). Sine-Aid contains 325 mg. of acetaminophen and 25 mg. of phenylpropanolamine (a decongestant).
We see a number of problems with these actively promoted nonprescription combination sinus headache drugs. Most of them contain an antihistamine. In allergic conditions, antihistamines are useful, but a large percentage of patients with sinus congestion and sinus headaches do not have allergy as a basis for their symptoms, so antihistamines in these instances are of little or no value. The decongestants contained in some of these preparations are poorly absorbed from the stomach when administered in tablet form and are thus relatively ineffective at recommended doses. When taken in excessive amounts, however, these decongestants can raise blood pressure and affect heart rate and circulation to various important organs and, therefore, should not be taken unless absolutely necessary and only after proper medical evaluation.
In general, the nonprescription combination analgesics and sinus headache medications offer a collection of drug ingredients that include aspirin, acetaminophen, and a number of extra ingredients that are of doubtful value for most people who turn to them for relief of their symptoms. Also, when taken in excessive amounts, these ingredients, including caffeine, may have adverse effects upon various body functions.
We doubt that these drugs have any significant benefit other than the effect of the simple aspirin or acetaminophen that they contain. Yet these combination substances are considerably more expensive than an aspirin or an acetaminophen tablet.
We recognize that many people believe that they benefit from these combination drugs, and perhaps some do. But we do not think that the “shotgun” approach to symptoms provided by these combination-of-ingredient drugs is a medically sound way to treat disease. Such an approach forces often misinformed patients to take either unnecessary or potentially hazardous substances for their particular medical condition.
We suspect that many people who believe that they benefit from these drugs are benefiting from the simple analgesics in them and perhaps from some placebo effect as well.
We suggest that patients with pain, particularly head pain, take simple aspirin or acetaminophen in the appropriate dosages with a glass of water and a little light food to help avoid stomach discomfort. If adequate pain relief is not achieved after a reasonable time, medical advice should be sought. Relying on regular or excessive use of these combination tablets exposes you to many potential hazards. Also, as we have already suggested, too much caffeine can actually cause headaches as well as a variety of other symptoms. And keep in mind that the caffeine ingested when you take these medications adds to the caffeine that is in foods and beverages.
All these warnings about nonprescription combination medications hold true for the prescription combination drugs as well. The mere fact that they require a prescription does not mean that they are effective. A major difference with prescription drugs is that there is a source of accountability and control?your physician. You can ask your doctor about the ingredients in the medication prescribed, the appropriate doses for you, and the potential side effects.
As mentioned earlier in the discussion of the placebo response, recent research suggests that the brain is capable of producing its own “analgesics.” These substances have been called endorphins, and they possess a remarkable similarity to morphine, one of the most potent narcotic analgesics. The widespread implications of these findings have not yet been fully appreciated. How the brain relieves its own perception of pain, what mechanisms or conditions raise the levels of these endorphins in the brain, what lowers them, and how painful disorders or helpful therapies affect the endorphin system are but a few of the important questions that scientific research is currently attempting to answer. Acupuncture may, for example, temporarily diminish sensations of pain by causing an elevation of the endorphin level.
These and future breakthroughs will ultimately lead to a better understanding of the mysteries of pain and the drugs used to treat it.
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