What over the counter pain medicine is best

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When pain strikes—whether it’s an annoying headache or killer period cramps—you probably have a go-to OTC pain reliever that you reach for (and no judgment if it’s whatever you happen to have in your medicine cabinet or handbag). But here’s the thing: Not all OTC pain meds are created equal. Some are better suited to treat specific kinds of pain; for example, the pill you pop for period cramps may not be the best one for relieving a headache. Here’s a rundown of the pain meds you’ll find at the drugstore, plus the best pain reliever for each type of pain so you can find relief fast.

OTC pain relievers to choose from | NSAIDs | Acetaminophen | Combined pain relievers | Topical pain relievers | Prescription medications | Best pain reliever by pain type

What are the different OTC pain relievers to choose from?

There are two main types of OTC pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, and acetaminophen (Tylenol). NSAIDs can be broken down further into different categories, and there are even a few OTC meds that combine an NSAID and acetaminophen into one pill. There are also topical formulations available that can be rubbed into the skin. Confused yet? Keep reading to learn more about each type.

What are NSAIDs?

As the name suggests, nonsteroidal anti-inflammatory drugs block the release of chemicals that cause inflammation and pain, namely prostaglandins, a group of hormone-like compounds. Prostaglandins play many roles in your body, but one is that they can produce fever, inflammation, and pain.1 The pain is due to how prostaglandins irritate nerve endings and influence your perception of pain, according to the American Academy of Family Physicians. That’s where NSAIDs come in—they reduce the level of prostaglandins in your body, which, in turn, helps reduce pain and inflammation, Niket Sonpal, MD, assistant professor at Touro College of Osteopathic Medicine in New York, tells SELF.

However, using NSAIDs on the regular can potentially cause significant side effects or complications, he warns, including an upset stomach, stomach ulcers, and kidney damage.2 Prostaglandins protect your stomach lining and help maintain kidney function, so in suppressing them to nix pain, you end up trading one issue for another, Dr. Sonpal explains. A good rule of thumb is to take NSAIDs for no more than 3 days for fever or 10 days for pain, unless your doctor tells you otherwise, according to the Cleveland Clinic. With that in mind, here’s what you need to know about the different types of NSAIDs you’ll find at the drugstore.

Aspirin

First up is aspirin (Bayer), which some people still use to treat mild-to-moderate aches and pains, including headaches, pulled muscles, and arthritis, but doctors generally recommend other, more effective pain relievers these days. For people with heart disease, though, this type of NSAID has special benefits. “Unlike other NSAIDs, aspirin is considered cardioprotective in patients with certain risk factors by acting as a blood thinner,” says Dr. Sonpal. Translation: In general, aspirin comes with a decreased risk of heart attack or stroke. Why? Since aspirin acts as a blood thinner, you’re less likely to have a blood clot that can lead to these health emergencies, according to the U.S. National Library of Medicine.

Another time to reach for the aspirin? When a migraine attack strikes out of nowhere. One 2019 study published in The American Journal of Medicine found that taking aspirin at the first sign of symptoms was a safe and effective treatment. It’s also a low-cost option for people who may not have insurance or the ability to pay for pricey migraine drugs.4

If you do decide to pop an aspirin, make sure to take it with food, since taking too much or taking it on an empty stomach can cause G.I. upset and ulcers.

Ibuprofen and naproxen

Ibuprofen (Advil and Motrin) and naproxen (Aleve) are also on team NSAID. They’re great for treating pain from muscle aches and stiffness, inflammation from injuries, and menstrual cramps. Ibuprofen and naproxen are both stronger than aspirin, but naproxen wins as the strongest pain reliever currently available without a prescription. That said, with stronger meds comes an opportunity for increased risk of side effects, so it’s important to weigh the risks against your pain-relieving needs. “If you have a history of G.I. or kidney issues, you should avoid this class entirely,” Nicole Van Groningen, MD, an internist at the Cedars Sinai, tells SELF.

A few other cautions about NSAIDs: They shouldn’t be mixed with alcohol, and it’s best to check in with your doctor before taking them if you’re pregnant, have allergies, or are taking other medications.

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What is acetaminophen?

Similar to NSAIDs, acetaminophen (Tylenol) is a star at relieving headaches, easing minor aches and pains, and reducing fever, but it falls short in the inflammation department. Acetaminophen is not an anti-inflammatory agent, so it won’t reduce symptoms caused by inflammation like swelling.3 It also works a bit differently than NSAIDs. It seems to work on the parts of the brain that receive pain messages and controls body temperature, per the American Academy of Family Physicians.

It’s also easier on the stomach and generally has fewer side effects than NSAIDs. That’s why it’s recommended for long-term use, for young children, and for people who are pregnant. But it’s important that you take the proper dose to avoid complications. At very high doses, which can mean one super high dose or a too-high dose over several days, acetaminophen can cause acute liver failure, according to the Mayo Clinic.

You’ll also need to avoid happy hour while taking acetaminophen since it can lead to liver toxicity, says Dr. Van Groningen.

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What are combination pain relievers?

There are a few OTC pain relievers that combine aspirin and/or acetaminophen with caffeine. The reason? Caffeine may help these pain relievers work better. In a 2014 study published in the Cochrane Database of Systemic Reviews, researchers found that pain relievers containing 100 mg or more of caffeine provided more pain relief than pain killers alone.5

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What are topical pain relievers?

Whether you’re sore from an intense workout or you sprained your ankle during a run, a topical pain reliever can help. They come in the form of creams, patches, gels, and sprays, and they are absorbed into the skin to reduce pain and inflammation in the area you apply them.

Topical pain relievers can include ingredients such as methyl salicylate and menthol (which both give a cooling sensation), NSAIDs (to relieve pain), and capsaicin (a compound of chili peppers that produces a warming sensation), according to the Cleveland Clinic. Capsaicin helps reduce pain by essentially desensitizing your nerves.6

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What about prescription pain relievers?

If you’re dealing with chronic or severe pain after an accident or injury, OTC pain killers may not cut it. In these situations, your doctor may provide a prescription pain reliever. Things like opioids, antidepressants, anticonvulsants, muscle relaxers, and corticosteroids all fall into this category, according to the Cleveland Clinic. One note of caution about prescription pain relievers is that with stronger medications comes more risks, including the potential for substance abuse. For this reason, your doctor will likely only prescribe a short course of these medications.

Whether you are taking prescription or OTC drugs, it’s a good idea to keep a list of all the medications, vitamins, and supplements you take so your doctor and pharmacist can be aware of any harmful interactions that could occur between medications.

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What is the best pain reliever for each pain type?

Knowing about all of the OTC pain relievers out there is one thing, but understanding when to use each type of medication is another. Whether you’re dealing with a splitting headache or unbearable period cramps, here’s how to know which is the best pain reliever for your situation. And remember, if you aren’t sure about what type of medication you need, it’s always best to check in with your doctor first.

The problem: Aches and pains in your muscles and joints

Consider: Ibuprofen or naproxen

Any type of acute pain, typically from an injury or overused muscles and joints, will benefit from the anti-inflammatory effect of an NSAID. How much you need to take comes down to swelling and the type of problem that’s occurring. One Aleve pill typically has 220 mg of naproxen, which Dr. Sonpal says is enough for pain that pops up in everyday life. But, if you’re dealing with chronic pain, like gout or arthritis, that may not be enough. “You may need higher doses as directed by a physician,” he says.

For run-of-the-mill aches and pains, follow the dosage directions on the bottle. But, for severe or ongoing pain that involves swelling, it is a good idea to check in with your doctor. They may prescribe different pain medications or recommend other treatment options.

The problem: A fever that just won’t quit

Consider: Acetaminophen

“Acetaminophen is classically used for fever, and it’s still what I recommend,” says Dr. Van Groningen. Although NSAIDs have the same effect, acetaminophen is less likely to cause stomach issues. One caveat: “Be careful taking it if you’re also taking OTC cold and flu medications,” she warns. “These often contain acetaminophen, so if you’re taking max doses of acetaminophen and cold medicine, you could be overdoing it and risking liver damage.”

The problem: Unbearable period cramps

Consider: Ibuprofen or naproxen

The major cause of menstrual cramps is—surprise, surprise—the release of prostaglandins, which causes the uterus to contract. The good news is that NSAIDs work really well to treat this kind of pain (and other strange pains you might have during your period), and you can even get ahead of it. “For women with significant menstrual pain and who have predictable periods, I recommend starting ibuprofen or naproxen a day or two before your period starts,” says Dr. Van Groningen. That will keep your baseline level of pain in check until your monthly visitor exits the building.

If you want to add in some non-medication pain relief tips to keep your cramps at bay, the American College of Obstetricians and Gynecologists has a few ideas:

1. Get moving: Try to do some kind of physical activity most days of the week. Aerobic activities like walking, running, biking, and swimming actually produce chemicals that can help block pain.
2. Turn up the heat: Putting a heating pad or hot water bottle on your abdomen can soothe period pains. Soaking in a warm bath (with bubbles for extra comfort) can help, too.
3. Prioritize rest as much as possible: Having your period can take a lot out of you. That’s why it’s important to get enough sleep before and during your period. Sleep is rejuvenating and can help you cope with pain and discomfort.
4. Chill out: Practicing relaxation, through meditation or yoga, for example, can also help you deal with pain better.

The problem: A run-of-the-mill headache

Consider: Acetaminophen or an NSAID

If your mom insists you take acetaminophen for headaches, but you think ibuprofen works better, well, you’re both right. Which pain reliever works best for headaches is really an individual thing—basically, use whichever med gives you better relief, says Dr. Van Groningen. But try not to overdo it—that means only reaching for the bottle a few times a week. “If you’re taking these medications more than that, it can lead to a medication overuse headache,7 which only goes away when you stop taking the medication,” she says.

The problem: Head-splitting migraine pain

Consider: Acetaminophen and aspirin

“Migraine head pain can be much trickier to treat than garden variety tension headaches,” says Dr. Van Groningen, who says the best pain reliever for this is an acetaminophen and NSAID hybrid, such as Excedrin Migraine. “If you’re concerned that the headache you’re having is a migraine and it’s not responding well to OTC options, there are plenty of prescription medications that can help treat and prevent migraine attacks,” she says.

Many people with migraine grapple with more than head pain during an attack, too, such as nausea and vomiting. Some migraine medications are aimed at targeting these symptoms, so you don’t have to just grin and bear it. Having a frank discussion with your doctor about your symptoms can put you on a better migraine treatment journey.

The problem: Severe pain of any kind

Consider: A trip to the doctor

Whether you’re experiencing intense and throbbing head pain, lightning sharp jolts after taking a tumble, or excruciating abdominal pain, popping an OTC pain reliever probably isn’t going to fix the problem. Severe pain, of any kind, really requires a trip to the emergency room, urgent care, or your primary care doctor. Think of it this way: It’s better to get to the root of the pain (and treat it) sooner rather than later.