Headaches can have multiple causes, and not all painkillers work the same. This medical guide explains when to use paracetamol, ibuprofen, aspirin, or ketorolac.
Headaches are one of the most common reasons for consultations worldwide and can be caused by multiple factors such as stress, dehydration, muscle tension, or even more complex disorders like migraines.
To relieve it, millions of people turn to over-the-counter medications, but which is the most effective option among paracetamol, ibuprofen, aspirin, and ketorolac?
Choosing the right pain reliever depends on the type and intensity of the pain, as well as each person’s specific medical conditions.
Although all of these drugs help relieve pain, they do not work in the same way or have the same side effects.
Paracetamol: first choice for mild pain and in people at gastric risk
Paracetamol (also known as acetaminophen) is effective in relieving mild headaches, especially when associated with fever or malaise.
It acts on the central nervous system by inhibiting the production of prostaglandins—compounds that transmit pain—without affecting peripheral inflammation.
Common indications:
- Mild headaches or those associated with fever.
- Patients with gastrointestinal problems or at risk of bleeding.
- Children and pregnant women, always be under medical doctor.
- Although its anti-inflammatory effect is minimal, paracetamol is considered a safe and effective option for non-complex cases.
Ibuprofen: effective against pain with an inflammatory component
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting COX-1 and COX-2 enzymes throughout the body, reducing the production of prostaglandins that cause inflammation, pain, and fever.
Useful in:
- A moderate headache accompanied by muscle tension in the neck, jaw, or cervical area.
- Headaches are caused by contractures, bruxism, or poor posture.
- Thanks to its anti-inflammatory effect, ibuprofen is ideal when pain is related to muscle tension or pressure.
Aspirin: an accessible painkiller with anticoagulant effects
Acetylsalicylic acid, also known as aspirin, blocks the COX-1 and COX-2 enzymes, which helps reduce pain and inflammation. However, unlike other NSAIDs, it irreversibly inhibits platelet aggregation, so it also acts as a mild anticoagulant.
It is recommended in:
- Mild, occasional headaches with no history of bleeding.
- Situations where a moderate and sustained anti-inflammatory effect is desired.
- However, prolonged use should be avoided in people at risk of bleeding or gastrointestinal disorders.
Ketorolac: Powerful analgesic for acute cases, but with caution
Ketorolac is a second-generation NSAID with greater analgesic potency than ibuprofen. It acts quickly and profoundly on both the central and peripheral nervous systems, and is capable of relieving intense pain such as severe migraines.
Specific indications:
- Severe headache that does not respond to other painkillers.
- Acute migraine attacks.
However, due to its high gastric and renal toxicity, ketorolac should only be used for short periods and under strict medical supervision.