Asking the right questions: making an appropriate recommendation for relief of acute headaches

Headaches are a common feature of numerous clinical conditions,¹ yet most cases are not linked to any underlying disorder.

Known as primary headaches, these include tension‑type and cluster headaches,¹ and account for almost 98% of all headache presentations.²

In contrast, secondary headaches (those arising as a consequence of another condition or disorder) and painful cranial neuropathies occur far less often.¹

Although headaches are usually not serious, repeated episodes can have a considerable impact on a patient’s day‑to‑day functioning. Recurring pain may affect social and family life, reduce overall quality of life, and interfere with productivity and work performance.³

Patients frequently turn to healthcare professionals for advice on suitable pain relief options. When offering a recommendation, it’s important to recognise that individual needs differ, and several factors should guide your decision. Taking these into account helps ensure the advice you provide is appropriately tailored and genuinely helpful.

Check for red flags and determine symptoms

Begin by determining whether the patient shows any red flag symptoms that could point to a secondary cause and/or warrant urgent specialist input.¹

To do this, you might ask questions such as:⁴

• Did the headache start suddenly and reach peak intensity within five minutes?
• Is the headache getting progressively worse?
• Is the headache brought on by physical exertion or by coughing?
• Have you had a sudden acute headache associated with loss of consciousness or altered awareness?
• Have you experienced any head injury in the last three months?
• Is it accompanied by fever or signs of another illness?

A ‘yes’ to any of these should prompt you to consider referral for specialist assessment, or possibly immediate admission, based on your clinical judgement and the level of urgency.

Once red flags have been ruled out, you can move on to characterising the patient’s symptoms in more detail.⁵ Useful questions include:

• How often do the headaches occur, i.e. are they episodic, daily, and on how many days per month?
• How would you describe the nature of the pain, e.g. pressing, pulsating, stabbing, or something else?
• Where is the pain located (head, face, neck, etc.), and does it spread to other areas?
• Are there associated symptoms such as photophobia, phonophobia, nausea, or vomiting?

Understanding the patient’s medication background

A clear picture of the patient’s current and past treatments is essential. Consider asking:

• Is there a family history of headache disorders?
• Do your headaches have particular triggers?
• Are you currently taking any prescribed or over‑the‑counter medicines? If so, which ones and at what doses?
• What treatments have you previously tried for your headaches?

For patients experiencing ongoing or recurring headaches, a headache diary can be a valuable tool. Recording details such as frequency, duration, and intensity can support more meaningful discussions about how the condition affects them and help evaluate the impact of any interventions.⁶

Recommending an appropriate pain relief option

Once you have ruled out secondary causes and gathered a full clinical picture, you can begin considering suitable treatment options. A range of non‑pharmacological approaches may be helpful. For example, encouraging relaxation strategies, improving sleep habits, using a low, firm pillow, or applying heat or cold packs, particularly if neck pain accompanies the headache.⁷

For the acute management of tension‑type headaches, NICE guidelines recommend starting with simple over‑the‑counter analgesics such as paracetamol, aspirin, or a non‑steroidal anti‑inflammatory drug (NSAID).⁶

Paracetamol is appropriate for use in approximately 98% of the population,*⁸ making it a reliable option for many groups, including the majority of:⁹

• Older adults
• Patients with a history of stomach ulcer
• Patients with asthma**
• Patients with cardiovascular disease

It generally has a strong safety profile, with relatively few drug interactions and concerns mainly arising in the context of significant overdose. This means paracetamol is often likely to be compatible with other medications a patient may be taking.¹⁰

Note: Always review the full product label when considering any recommendation to ensure it is suitable for the specific patient.

Some paracetamol formulations are different

Different paracetamol tablet formulations can vary in how rapidly and effectively they provide pain relief, making the choice of product an important consideration for patient care.

For instance, adding caffeine to paracetamol can substantially enhance its analgesic effect.¹¹ Caffeine blocks adenosine receptors, influencing pain pathways both centrally and peripherally,¹² and may also inhibit cyclo‑oxygenase activity, which contributes to its adjuvant and antinociceptive properties.¹³

In addition, some formulations are designed to break down more quickly once ingested, allowing paracetamol to be absorbed faster.

Within the Panadol range are products which contain formulations specifically developed to optimise the pain‑relieving performance of paracetamol:

• The dual paracetamol and caffeine formulation of Panadol Extra film-coated tablets helps patients fight tough pain.¹⁴
• The unique Optizorb® technology used in Panadol 500mg Film Coated Tablets (paracetamol) and Panadol Extra film coated tablets features super-disintegrants that speed up the disintegration of the tablet in the stomach.¹⁵

Headaches are a common complaint, and can have a noticeable effect on a patient’s day‑to‑day wellbeing. By guiding the conversation with the right questions and recommending an appropriate, effective over‑the‑counter analgesic, you can help patients to manage their pain and get back to their day.

Panadol 500mg Film Coated Tablets and Panadol Extra Film-coated Tablets contain paracetamol. Always read the label/leaflet.

*Data was collected from 107,553 patients (18-75 years) using OTC analgesics in Australia. Overall 1.9% of patients had ≥1 contraindication, warning or precaution to paracetamol use

**Bronchospasm has been reported very rarely in patients sensitive to NSAIDs and aspirin

References

1. NICE CKS. Headache: assessment. Available at: https://cks.nice.org.uk/topics/headache-assessment/. Accessed November 2025.
2. Ahmed F. Headache disorders: differentiating and managing the common subtypes. Br J Pain. 2012 Aug;6(3):124-32.
3. World Health Organization. Migraine and other headache disorders. Available at: https://www.who.int/news-room/fact-sheets/detail/headache-disorders. Accessed November 2025.
4. NICE Guidance. Headaches in over 12s: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg150/chapter/Recommendations#assessment. Accessed November 2025.
5. Speciali JG, Eckeli AL, Dach F. Tension-type headache. Expert Rev Neurother. 2008 May;8(5):839-53.
6. NICE CKS. Management of tension-type headache. Available at: https://cks.nice.org.uk/topics/headache-tension-type/management/management/. Accessed November 2025
7. Tension headaches. Available at: https://www.nhs.uk/conditions/tension-headaches/. Accessed January 2026.
8. Clarke GD, et al. Int J Pharm Pract. 2008;16:1-4
9. Graham GG, Scott KF, Day RO. Drug Saf. 2005;28(3):227-40.
10. Sharma CV, Mehta V, Paracetamol: mechanisms and updates, Continuing Education in Anaesthesia Critical Care & Pain, 2014; 14(4):53–158
11. Laska EM, Sunshine A, Mueller F, Elvers WB, Siegel C, Rubin A. Caffeine as an Analgesic Adjuvant. 1984;251(13):1711–1718.
12. Baratloo A et al. Anesth Pain Med 2016;6(3):e33193.
13. Fiebich BL et al. Neuropharmacology 2000;38:2205–13.
14. Wilson CG, et al. Drug Dev Ind Pharm 2011
15. Haleon Data on File, Study A1900265.

Product Information:

Panadol 500mg Film Coated Tablets (paracetamol). Indications: Short-term management of headaches, musculoskeletal disorders, menstrual pains, toothache, symptoms of colds and flu, mild to moderate pain associated with diagnosed osteoarthritis. Dosage: Adults (including the elderly) and children 16 years and over: 1-2 tablets, up to 4 times daily, as required. Children aged 10-15 years of age: 1 tablet, up to 4 times daily as required. Max 4 doses in 24 hours. Do not give to children for more than 3 days without consulting a doctor. Do not give to children under 10 years. Minimum dosage interval is 4 hours. Contraindications: Hypersensitivity to paracetamol or any of the other ingredients. Precautions: Do not use with any other paracetamol-containing products. Use with caution in patients with depleted glutathione levels / glutathione depleted states. Those diagnosed with liver or kidney impairment must seek medical advice before use. Caution, regarding paracetamol, if used at therapeutic doses for a prolonged period or administered concomitantly with flucloxacillin due to increased risk of high anion gap metabolic acidosis (HAGMA), particularly in patients with severe renal impairment, sepsis, malnutrition and other sources of glutathione deficiency (e.g. chronic alcoholism). If suspected, discontinue use promptly and monitor closely, including measurement of urinary 5-oxoproline. Do not exceed the stated dose. Prolonged use, except under medical supervision, may be harmful. Side effects: Very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angioedema, Stevens-Johnson syndrome, Toxic Epidermal Necrolysis, serious skin reactions, bronchospasm, hepatic dysfunction. Not known: High anion gap metabolic acidosis.  Legal Category: 12 Tablets GSL; 24 Tablets Pharmacy Only. MA Number: PA 678/107/1. MA Holder: Haleon Ireland Limited, Clocherane, Youghal Road, Dungarvan, Co. Waterford, X35 Y983, Ireland. Text prepared: June 2025. Further information available on request.

Panadol Extra Film-coated Tablets (paracetamol 500mg, caffeine 65mg). Indications: Mild to moderate pain including rheumatism, neuralgia, musculoskeletal disorders, headache, toothache, menstrual pain, discomfort of flu, fever and feverish colds. Dosage: Adults and children 16 years and over: 2 tablets up to 4 times a day. Do not exceed 8 tablets in 24 hours. May need a lower dose if underweight (<50kg), malnourished, dehydrated or have alcohol problems. Children aged 12- 15 years: 1 tablet up to four times daily. Do not exceed 4 tablets in 24 hours. Do not give to children under 12 years. Minimum dosage interval: 4 hours. The lowest dose necessary to achieve efficacy should be used. Contraindications: Hypersensitivity to paracetamol, caffeine or any of the other ingredients. Precautions: Do not use with any other paracetamol-containing products. The concomitant use with other products containing paracetamol may lead to an overdose. Paracetamol overdose may cause liver failure which can lead to liver transplant or death. Use with caution in patients on concomitant treatment with drugs that induce hepatic enzymes and in patients with risk factors for hepatotoxicity (see SPC for further details). Patients diagnosed with liver or kidney impairment must seek medical advice before use. Caution, regarding paracetamol, if used at therapeutic doses for a prolonged period or administered concomitantly with flucloxacillin due to increased risk of high anion gap metabolic acidosis (HAGMA), particularly in patients with severe renal impairment, sepsis, malnutrition and other sources of glutathione deficiency (e.g. chronic alcoholism). If suspected, discontinue use promptly and monitor closely, including measurement of urinary 5-oxoproline.   Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. If high fever, or signs of secondary infection occur of if symptoms persist for longer than 3 days, consult your doctor. Contains parahydroxybenzoates, which may cause allergic reactions (possibly delayed). Avoid excessive concurrent caffeine intake. Side effects: Very rare cases of serious skin reactions have been reported. (paracetamol) Very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angioedema, Stevens-Johnson syndrome, Toxic Epidermal Necrolysis, bronchospasm, hepatic dysfunction. Unknown: High anion gap metabolic acidosis.  (caffeine) Frequency unknown: Nervousness, dizziness. insomnia, restlessness, anxiety, irritability, gastrointestinal disturbances and palpitations. MA Holder: Haleon Ireland Limited, Clocherane, Youghal Road, Dungarvan, Co. Waterford, X35 Y983, Ireland MA Number: PA 678/27/1. Legal Category: 12 Tablets GSL; 24 Tablets Pharmacy Only. Text revised: Jan 2026. Further information available on request.

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