Only 10% people with tension-type headaches get a benefit from paracetamol

Tension-type headache affects about 1 person in 5 worldwide. People with frequent, or acute episodic, tension-type headache have between two and 14 headaches every month. Tension-type headache stops people concentrating and working properly. When headaches do occur, they get better over time, even without treatment.

Paracetamol, which is also known as acetaminophen, Tylenol®, Calpol®, or Panadol®, is a commonly used painkiller, available without prescription in most parts of the world. The usual dose is 1000 mg, usually in two tablets taken by mouth.

A team of Cochrane authors based in United Kingdom worked with Cochrane Pain, Palliative and Supportive Care to assess the usefulness and safety of a single dose of paracetamol for the treatment of frequent tension-type headaches in adults. 23 studies were included with 8,079 participants who were 18 years or older with frequent tension-type headache, and with moderate or severe pain at start of the treatment. About 6,000 participants were involved in comparisons between paracetamol 1000 mg and placebo.

The International Headache Society recommends the outcome of being pain free two hours after taking a medicine. The outcome of being pain free or having only mild pain at two hours was reported by 59 in 100 people taking paracetamol 1000 mg, and in 49 out of 100 people taking placebo. This means that only 10 in 100 or 10% of people benefited because of paracetamol 1000 mg.

About 10 in 100 people taking paracetamol 1000 mg reported having a side effect, which was the same as with placebo (9 in 100 people) (high quality evidence). Most side effects were mild or moderate in intensity. No side effects were serious.

“Many headache suffers take Tylenol or paracetamol for relief. This Cochrane Review shows that there may only be a small benefit from a single dose of paracetamol 1000 mg to those with frequent tension-type headaches. Of course, paracetamol is not harmless when taken in large doses or over long periods of time,” said Andrew Moore, one of the authors of the Cochrane Review. “These results are important for two reasons. One is that they form part of a series of reviews into frequent tension-type headaches, hopefully to identify more efficient treatments. The other is to improve the way clinical trials are done in future to provide more relevant information about treating this common and often disabling condition.”  

Read the full Cochrane Review (summary available in Croatian)

Visit the Pain, Palliative and Supportive Care Group website

Other Cochrane Reviews on frequent tension-type headaches:

• Oral ibuprofen for acute treatment of episodic tension-type headache in adults
• Acupuncture for tension-type headache
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for preventing tension-type headache

Related Resources:

• ‘How Effective Is Acetaminophen in Tension-Type Headaches’ on Oncology Nurse Advisor.
• Editorial - Paracetamol and pain: the kiloton problem in the European Journal of Hospital Pharmacy.