ASA/Acetaminophen+
caffeine +/-(codeine)
Place In Therapy
Combination products with caffeine and simple analgesics and/or NSAIDs have evidence from several randomized controlled trials and review articles for superior effectiveness compared to acetaminophen or NSAID monotherapy 1,2,3,4. However, caffeine-containing products increase the risk of medication-overuse headaches and other side effects such as dizziness 4. Therefore, combination products with caffeine are recommended as second-line therapy for use in tension-type headaches which do not respond to acetaminophen or NSAIDs.
Codeine-containing products have no trials demonstrating efficacy and have a high risk of medication-overuse headache, dependence and other significant adverse effects4. Therefore over-the-counter combination products with codeine such as Tylenol #1 are not recommended for treating tension-type headach
References:
1. Pini LA, Del Bene E, Zanchin G. et al. Tolerability and efficacy of a combination of paracetamol and caffeine in the treatment of tension-type headache: a randomized, double-blind, double-dummy, cross-over study versus placebo and naproxen sodium. J Headache Pain 2008; 9:367 –373.
2. Diamond S and Freitag, FG. The Use of Ibuprofen Plus Caffeine to Treat Tension-type Headache. Current Pain and Headache Reports. 2001 [cited March 7, 2012]; 5: 472-478. Available from: PubMed
3. Diener HC, Pfaffenrath V, Pageler L, Peil H and Aicher B. The fixed combination of
acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination
for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-
controlled parallel group study. Cephalagia. 2005 [cited March 9, 2012[; 25: 776-787. Available from: PubMed
4. Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G and Schoenen J. EFNS guideline on the treatment
of tension-type headache – Report of an EFNS task force. European Journal of Neurology. 2010 [cited March 9, 2012]; 17: 1318-1325. Available from: PubMed.
Codeine-containing products have no trials demonstrating efficacy and have a high risk of medication-overuse headache, dependence and other significant adverse effects4. Therefore over-the-counter combination products with codeine such as Tylenol #1 are not recommended for treating tension-type headach
References:
1. Pini LA, Del Bene E, Zanchin G. et al. Tolerability and efficacy of a combination of paracetamol and caffeine in the treatment of tension-type headache: a randomized, double-blind, double-dummy, cross-over study versus placebo and naproxen sodium. J Headache Pain 2008; 9:367 –373.
2. Diamond S and Freitag, FG. The Use of Ibuprofen Plus Caffeine to Treat Tension-type Headache. Current Pain and Headache Reports. 2001 [cited March 7, 2012]; 5: 472-478. Available from: PubMed
3. Diener HC, Pfaffenrath V, Pageler L, Peil H and Aicher B. The fixed combination of
acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination
for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-
controlled parallel group study. Cephalagia. 2005 [cited March 9, 2012[; 25: 776-787. Available from: PubMed
4. Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G and Schoenen J. EFNS guideline on the treatment
of tension-type headache – Report of an EFNS task force. European Journal of Neurology. 2010 [cited March 9, 2012]; 17: 1318-1325. Available from: PubMed.