Understanding Painkillers Correctly! 2009/05/27
Wang Shu-Jun, Director of General Neurology, Taipei Veterans General Hospital

There are many types of headaches, with the most common being "migraine," "tension-type headache," and "cluster headache." Migraines and tension-type headaches account for nearly 90% of all headaches. The causes of pain vary from person to person, and only a very small number of headaches may indicate a serious underlying condition requiring immediate treatment. In fact, most headaches are not caused by brain abnormalities, so the chance of a headache being fatal is minimal. However, headaches can severely disrupt daily life.

Based on clinical experience, the three major types of headaches present the following symptoms:
1. **Migraine**: More common in female patients, occurring about three times more frequently than in males. Symptoms include headache accompanied by nausea, vomiting, photophobia (sensitivity to light), and phonophobia (sensitivity to noise).
2. **Tension-type headache**: Symptoms are milder, characterized by a tight sensation around both temples, often occurring in the afternoon. The discomfort is relatively mild, with women experiencing it about twice as often as men. Both migraines and tension-type headaches are often triggered by work-related stress.
3. **Cluster headache**: Predominantly affects males. The pain is severe and localized around one eye or temple, often mistaken for a migraine. During an attack, tearing and nasal discharge may occur, and episodes are linked to weather changes. The peak period is from November to March, with attacks occurring almost daily for several weeks before disappearing spontaneously.

Due to high work pressure, "tension-type headaches" and "migraines" are frequently triggered. However, a lack of proper medication knowledge often leads to either overuse of painkillers, worsening headaches, or an irrational fear of painkillers. Some online rumors, such as "one Panadol pill stays in the body for five years," scare people into avoiding painkillers even when headaches severely impair their quality of life. In reality, the claim that painkillers remain in the body for five years is baseless. Generally, painkillers take effect within 15 to 30 minutes, last for 4 to 6 hours, and are completely excreted from the body within about 24 hours, leaving no residue.

How can over-the-counter (OTC) painkillers be used effectively without risking addiction? I recommend following the principle of "use when necessary, save when possible." First, ensure that your headache has remained consistent over the years, with no significant changes month to month, and does not exceed four days per month. If so, you may consider self-medicating with painkillers following the advice below. If headaches increase in frequency or painkillers become less effective, consult a neurologist.

(1) **Find the right headache medication for you**: OTC painkillers are generally safe, with main ingredients being acetaminophen (e.g., Panadol) or aspirin (e.g., Bufferin). For mild to moderate headaches, these are usually effective. Test them a few times to confirm their efficacy.

(2) **Use when necessary**: A headache is like a storm in the brain—the later you take painkillers, the less effective they become. Taking medication at the onset of mild pain achieves 80% effectiveness, while waiting until the pain is severe reduces effectiveness to 30%. Therefore, the earlier you take painkillers, the better the relief. If headaches are severe and frequently disrupt work, household tasks, or school, it’s advisable to take medication at the first sign of an attack for maximum effect—unless you can rest or stay in bed that day. Many patients worry that not all mild headaches will escalate, making early medication seem unnecessary. Here’s a practical guideline: headaches occurring in the morning, around menstruation, or those that start as throbbing pain often worsen. Additionally, take medication early if you have an important event or meeting that day.In these cases, it's best for patients to take medication as soon as a headache starts.

(3) Be frugal when possible: Overusing headache medication can lead to rebound headaches, increasing the frequency of headaches. Generally, painkillers should not be taken for more than eight days a month. Note that this refers to eight days, not eight doses—there's no specific limit on the number of doses taken in a single day. Recent studies have found that excessive use of painkillers worsens headaches, typically when taken for more than ten days a month. Therefore, if headaches are too frequent, relying entirely on painkillers and taking them at the first sign of pain is not advisable. Instead, limit the number of days you take medication each month and seek a doctor's help to find a long-term solution for headaches.

Headaches are a common issue in daily life, and taking painkillers is a nuanced matter that often varies from person to person. Many myths and misconceptions about painkillers, such as "one Panadol pill stays in your body for five years," can be quite harmful.

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1. Foreign studies indicate that 5–9% of dialysis patients are caused by the abuse of anti-inflammatory painkillers. Among approximately 1,000 people who abuse painkillers annually, about 1.7 will require dialysis.
2. Lin Jieliang, director of the Toxicology Department at Linkou Chang Gung Memorial Hospital, mentioned, "As long as painkillers are used daily for more than six months, it may already constitute what is considered abuse."

From the above two pieces of information, it can be inferred that although painkillers can be completely metabolized or excreted from the body within 24 hours, the harm they cause to the human body is long-term, cumulative, and possibly even irreversible. When I was studying at China Medical University, my pharmacology teacher mentioned the concept of a "Panadol dialysis threshold," meaning that whether you take it slowly or quickly, once you consume a certain cumulative amount of Panadol, you will eventually need dialysis (this is what I heard from the teacher at the time; please correct me if I'm wrong).

If we add three words to the statement "one Panadol pill remains in the body for five years," making it "the damage from one Panadol pill remains in the body for five years," it becomes much more reasonable. All that’s left is to collect and analyze clinical data from patients who underwent dialysis due to Panadol use to verify this claim more precisely.

One of the best-selling Western medications worldwide is painkillers, with "endless business opportunities." A 2008 Associated Press analysis showed that from 1997 to 2005, the sales of five major painkillers in U.S. retail pharmacies nearly doubled. Pain, regardless of its cause, is often treated by simply blocking the pain transmission pathway. This ostrich-like mentality—akin to drinking poison to quench thirst—has somehow become the mainstream approach in medicine. In contrast, traditional Chinese medicine therapies like acupuncture, external treatments (topical applications), and massage, which are nearly non-toxic and address the root cause of pain, are relegated to "alternative medicine" or "complementary therapies," struggling to survive under the so-called "mainstream medicine." The Buddha spoke of the world being upside down—truly, his words are credible.

Shen Yaozi said, "The sun bakes the earth, dissipating all things."