Pain Relief: Which Do I Choose?

The last thing anyone wants to do when their head starts pounding is to spend a lot of brainpower on a solution. Way easier than googling various medicines or sifting through products at a pharmacy is reaching for whatever pain-relief bottle is on hand. In the moment, it doesn’t matter exactly what’s inside or even if it’s the best call for your situation. It seems to have worked fine in the past, and all you really care about is ending the pain and moving on with your day (or night). 

You may be surprised to find out that different pain relievers serve different purposes, and the best choice depends on both your type of pain and your medical history. So, what are the main types of over-the-counter (OTC) pain relief medicines, and how do they differ? 

Pain Relief Powerhouses 

Any time you take OTC medicine in response to pain, you’re either taking acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or a combination of the two. While acetaminophen and NSAIDs differ in a few important ways, they have several key things in common too. These include:

• Reducing fevers 
• Offering relief from minor aches and pains 
• Lasting for 4 to 6 hours 

• Are available in a variety of strengths 
• Are considered safe for people 12 and over (when taken properly, of course) 
• No prescription required 

On the surface, it may seem like you can’t go wrong when it comes to picking a pain reliever for your headache, but it’s a little more complicated than that. Let’s take a look at how acetaminophen and NSAIDs differ, and why it matters. 

Acetaminophen 

Even if you haven’t heard of “acetaminophen” until now, you’re probably familiar with the brand it’s commonly associated with: Tylenol. Usually taken orally, acetaminophen is actually the main ingredient in dozens of medicines—including Betr’s Pain Relief with Acetaminophen—and on the ingredient list of many more combination products.

What It’s Good For: In addition to headaches, acetaminophen is a good choice when you’re experiencing mild to moderate pain from muscle aches, menstrual periods, colds, sore throats, toothaches, backaches, vaccination reactions, and osteoarthritis. It also helps with fevers. 

How It Works: Its exact mechanism remains a bit of a mystery, but acetaminophen essentially alters the way your body interprets pain by raising your pain threshold—meaning that more pain is required before you sense it as discomfort. It fights fevers by signaling to your brain that your body temperature has risen and needs to be cooled. 

Possible Side Effects: Although side effects aren’t common when acetaminophen is taken properly (read those instructions!), it can cause rashes or itchy skin, nausea, and headaches. Less often, it can lead to more serious skin reactions, anemia, kidney damage, swelling in the face or lower legs, and difficulty breathing or swallowing. If you experience any of those or other side effects after taking acetaminophen, stop taking it and call your doctor (for less serious symptoms) or seek emergency medical attention (for more serious ones).  

Precautions: Taking too much acetaminophen can cause severe liver damage—especially when combined with heavy or long-term alcohol or drug use. In addition, some medications, when taken simultaneously, can reduce the acetaminophen’s ability to do its job. As always, contact your doctor if you’re unsure whether a medication is right for you. 

Nonsteroidal Anti-Inflammatory Drugs 

When “anti-inflammatory” is used in the context of medicine, it refers to the second category of OTC pain relievers: nonsteroidal anti-inflammatory drugs, or NSAIDs. All NSAIDs work similarly, but there are more than 20 different kinds to choose from, some of which are taken orally and others that are applied topically (to your skin).

What They’re Good For: There’s some major overlap in the situations for which both NSAIDs and acetaminophen may do the trick. Like the first category, NSAIDs can help with mild to moderate pain from headaches, body aches, menstrual periods, and arthritis, as well as fever. NSAIDs are also considered the go-to treatment for migraine headaches and post-surgery pain. The biggest difference between the two active ingredients is that NSAIDs—true to their name—also reduce inflammation. While inflammation is an important part of the healing process and the body’s natural response to infection and injury, too much of it can be a bad thing. 

Which NSAID is Best: Once you’ve narrowed your decision down to an anti-inflammatory, your next move is to pick one. Here are the three most common NSAIDs, with guidance for how to choose between them. (Spoiler: Your decision will likely depend on which one(s) not to take.)  

• Because ibuprofen (the active ingredient in Advil, Motrin, and Betr’s Pain Relief (NSAID)) can increase the risk of heart attack or stroke, individuals with high blood pressure (or a history of it) should avoid ibuprofen without approval from a doctor. People with kidney disease, liver issues, or heart disease should do the same. 
• Like ibuprofen, naproxen (the active ingredient in Aleve, Anaprox, and Betr’s Headache Pain Relief) is not recommended for people with a known risk of heart attack or stroke. In addition, pregnant women and individuals at risk of stomach bleeding, with asthma, or with kidney, liver, or heart disease shouldn’t take naproxen without a doctor’s greenlight. 
• In addition to reducing pain and inflammation, aspirin (which is easy to confuse as a brand name, but is actually made by brands such as Bayer) can also help lower the risk of heart attacks and strokes caused by blood clots. Individuals who are pregnant, suffering from heart disease, taking steroids, or on antidepressants should consult their doctor before taking aspirin. 

How They Work: Whenever a part of your body becomes inflamed, chemicals called prostaglandins stimulate nerve endings and radiate pain from the site of injury. NSAIDs work by blocking the enzyme that makes prostaglandins, which then reduces the inflammation, pain, and fever that result. 

Possible Side Effects: Beyond the risk factors mentioned above, in some cases, NSAIDs cause vomiting, nausea, heartburn, and stomach issues—all of which should be relayed to your doctor if they persist. Less frequently, NSAIDs cause more serious side effects such as hives, trouble breathing, swelling in the head, accelerated heartbeat, and red or black stools. Those symptoms warrant immediate medical care from your doctor or a trip to the ER. 

Precautions: Taking NSAIDs for longer or in larger doses than is recommended (again: instructions!) may lead to ulcers and/or bleeding in the stomach and intestines. Individuals at risk of heart attack or stroke should be extra careful when taking NSAIDs, and steer clear of those that increase those risks. Finally, because anti-inflammatories don’t interact well with all medications, it’s important to communicate openly and honestly with your doctor about everything you’re taking. 

The Wrap-Up 

In a nutshell, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are similar in that they’re both active ingredients in OTC pain relievers that fight fevers and alleviate minor aches and pains like headaches. When it comes to inflammation, though, they diverge; NSAIDs reduce it, while acetaminophen does not. Beyond that difference, choosing an appropriate pain reliever is mostly a matter of knowing your health status and history, including all risk factors and other medications you’re on.  

Now that you know more about your pain relief choices, you’re ready to make the best decision when your pain strikes—not just the most convenient one. When in doubt, talk to your doctor.