Widespread use of Aspirin for mild aches and pains including headache, is it advisable?

Updated: Nov 19, 2020

All over the world, Aspirin is used frequently for headaches and other kinds of pains. Most of the Hollywood movies always show it as a panacea for alcohol headache especially hangover the next morning.

The pharmaceutical giant Bayer, which first developed aspirin more than a century ago, sold $40 million worth of the painkiller in the United States in the first 12 weeks of 2011, according to research firm SymphonyIRI.

Aspirin is a non-steroidal anti-inflammatory agent, belonging to the class salicylates. It can also be known as ASA (acetylsalicylic acid). It is an analgesic and antipyretic (to reduce fever). Aspirin is a medication commonly used to relieve minor pains. Aspirin has also been used to prevent heart attacks and strokes.


Facts about Aspirin


Aspirin is a medication commonly used to relieve minor pains. Aspirin has also been used to prevent heart attacks and strokes. Aspirin, however, can also cause damage to the stomach and/or intestinal lining leading to the development of erosions ("small sores") and/or ulcers ("large sores"). Erosions may cause bleeding ("bleeding ulcers") and/or perforations ("holes in the stomach").

Low dose aspirin is used for the primary and secondary prevention of cardiovascular thromboembolic events. As a non-selective inhibitor of cyclooxygenase, aspirin use results in irreversible COX-1 inhibition leading to impaired platelet aggregation. However, aspirin also inhibits COX-1 activity in the gastric mucosa by suppressing the synthesis of protective prostaglandins. In doing so, this creates a state of the propensity for the development of aspirin-associated gastrointestinal ulcers and ulcer complications.

In simple terms, the pain associated with many headaches is chemically based. Specifically, when a headache occurs, a compound called prostaglandin (a hormone that helps send pain signals to the brain) is overproduced. Because of its anti-inflammatory properties, aspirin can block the activity of an enzyme which helps make prostaglandin, called cyclooxygenase-1 (COX-1). By blocking the effects of COX-1, aspirin thereby decreases the levels of prostaglandin in the body. Even though aspirin circulates throughout the entire body after you swallow it, the drug acts only at sites where prostaglandin is being actively produced. When the production of prostaglandin is impaired, the pain signals sensed by the brain stop. No more pain signals, no more headache.

But as it also works elsewhere on the cells which are producing prostaglandins that are useful to our body, e.g. stomach lining cells, aspirin will lead to damage of the stomach mucosa and thus ulceration of it.


On the NHS site, one can see the most common side-effects related to aspirin, i.e. “common side effects of aspirin happen in more than 1 in 100 people. Talk to your doctor or pharmacist if the side effects bother you or do not go away; mild indigestion, bleeding more easily than normal - because aspirin thins your blood it can sometimes make you bleed more easily. For example, you may get nosebleeds, bruise more easily, and if you cut yourself, the bleeding may take longer than normal to stop”.


Two studies, published in the Jan. 5 issue of The Lancet, offer the best evidence yet that H. pylori infection and prolonged NSAID use have a synergistic effect on the development of ulcers. An analysis of 25 major studies found that NSAID takers who also had H. pylori infection were 61 times more likely to develop ulcers than those who were not infected and did not take NSAIDs.


Pain relievers such as aspirin interfere with the stomach's ability to protect itself from damaging acids. These NSAIDs promote ulcers by disrupting the mucus that coats the stomach lining, and by disturbing other natural defenses against digestive juices. H. Pylori infection and NSAID use increased the risk of bleeding ulcers by nearly 2-fold and 5-fold, respectively. But when patients both took NSAIDs and were infected, they had a 6-fold greater risk.

Aspirin is a common cause of ulcers, even in patients not infected with H. pylori. With the administration of daily low-dose aspirin, GI mucosal damage occurs in approximately 40%–50% of patients; increased risk of GI bleeding is also observed. These risks typically peak closer to the beginning of therapy and increase with patient age.


Routine use of Aspirin – especially for headaches


Aspirin is among the most widely used medications in the US and is administered for an extensive variety of indications. Further, it is readily available over the counter. Aspirin originated as a medication to treat pain and inflammation, but due to its antiplatelet properties, it has evolved into a drug commonly used to prevent cardiovascular disease.

Some of the most common side effects of aspirin are related to the upper GI tract. These range from mild conditions, such as dyspepsia, to more severe side effects, such as Peptic Ulcer Disease (PUD) and severe GI bleeding. Chronic aspirin consumption is associated with lower GI bleeding in more than 50% of aspirin users, indicating that GI injury is not only limited to the upper GI tract. Overall, aspirin has emerged as one of the most prominent causes of peptic ulcer bleeding in developed countries over the last 2 decades and is associated with a 2 to 4-fold increased risk of upper GI bleeding and ulcers.


Aspirin in Children


Just a few decades ago, aspirin was a widely used medication both for pain and fever reduction. It was given to everyone from babies to the elderly. However, today it is not recommended for children at all. Unfortunately, some people aren't aware of the current recommendations and continue to give aspirin to their kids or grandkids when they have a fever or pain.


It turns out that giving aspirin to children during a viral illness—most often influenza (the flu) or chickenpox—can lead to a potentially fatal condition called Reye's syndrome. Reye's is defined by sudden brain damage and liver function problems. It can cause seizures, coma, and death.


Reye's (Reye) syndrome is a rare but serious condition that causes swelling in the liver and brain. Reye's syndrome most often affects children and teenagers recovering from a viral infection, most commonly the flu or chickenpox.

Never give aspirin to children under the age of 16 (unless their doctor prescribes it). It can make children more likely to develop a very rare but serious illness called Reye's syndrome.


Dr. Neena S. Abraham, a gastroenterologist at the Michael E. DeBakey V.A. Medical Center and associate professor of medicine at the Baylor College of Medicine in Houston, says that “If your physician has suggested you take aspirin to reduce your risk of heart disease, it is important to remember that even small doses of daily aspirin — including “baby aspirin,” at a dose of 81 milligrams daily — can increase your risk of ulcers and bleed. It is important to remember that all NSAIDs, including over the counter aspirin, have the potential to damage the tissue of the gastrointestinal tract. Damage can occur anywhere, from mouth to anus. Over-the-counter doses of aspirin, or buffered or enteric-coated aspirin preparations, do not eliminate the risk of developing a NSAID-related ulcer. Your risk for bleeding is still two- to four-fold greater than if you were not taking the aspirin product at all. This risk increases in magnitude as the dose of the aspirin increases. Some studies have suggested that one-third of aspirin-induced ulcers are related to over-the-counter aspirin use. The excess ulcer bleeding risk associated with aspirin use is estimated at 5 extra cases per 1,000 patients per year.”

Aspirin is not the best choice for headaches or migraines


“Migraine sufferers could find relief in three aspirin tablets,” reported The Times. It said that researchers have suggested that one in four migraine sufferers could be pain-free within two hours if they take up to 1,000mg of aspirin in one go. Also, the review found no evidence that aspirin was any more effective than sumatriptan, the most common migraine treatment, or other migraine treatments. The review found no evidence that aspirin is more effective than other migraine treatments, and the Mail’s headline, “Why aspirin could be the best remedy for a migraine”, is incorrect.

Aspirin is not without adverse effects. Regular use can increase the risk of stomach irritation and ulceration, particularly in elderly people. It is also not a suitable treatment for everyone and should be used with caution by people with asthma and those who have a history of bleeding conditions. Taking three high-dose tablets at once may increase the risk of side effects in people who are susceptible to them.

People should also be aware that aspirin, like any medication, carries a risk of side effects. Used regularly, Moore noted, the drug may lead to problems like ulcers and gastrointestinal bleeding, and older adults — who are at increased risk of such problems — should be particularly cautious about frequently using aspirin for pain relief.


If you are taking this medication as needed (not on a regular schedule), remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medicine may not work as well. Aspirin with a special coating (enteric coating) or slow release may take longer to stop the pain because it is absorbed more slowly. Ask your doctor or pharmacist to help select the best type of aspirin for you.


More research is needed to determine the benefits and risks of daily aspirin use in adults younger than age 50 and older than age 70 before a recommendation can be made for or against aspirin use to prevent cardiovascular disease and colorectal cancer for these age groups.


Although aspirin has been recommended in the past for certain groups of people without a history of heart attack, there's some disagreement among experts about whether the benefits of aspirin outweigh its potential risks.


The Food and Drug Administration doesn't recommend aspirin therapy for the prevention of heart attacks in people who haven't already had a heart attack, stroke, or another cardiovascular condition.


Alternatives to Aspirin


Better alternatives to aspirin will be acetaminophen (paracetamol), Ibuprofen, or mefenamic acid. The latter two belong to the NSAIDs class of drugs.

Acetaminophen's effectiveness in reducing pain and fever is equivalent to that of aspirin, but, unlike aspirin, it has little or no clinically significant antirheumatic effect, according to A.M.A. Drug Evaluations, a reference work compiled by the American Medical Association's department of drugs in cooperation with the American Society for Clinical Pharmacology and Therapeutics. The drug is believed to raise the pain threshold by blocking the generation of pain impulses in the nervous system. It is said to reduce fever through effects on the heat-regulating center of the hypothalamus, a structure deep in the brain. Adverse reactions to acetaminophen are said to be infrequent. Paracetamol takes up to an hour to work. The usual dose of paracetamol is one or two 500mg tablets at a time. Do not take paracetamol with other medicines containing paracetamol. Paracetamol is safe to take in pregnancy and while breastfeeding, at recommended doses. Brand names include Disprol, Hedex, Medinol, and Panadol. Most people can take paracetamol safely, including pregnant and breastfeeding women. However, some people need to take extra care with paracetamol. Check with your doctor or pharmacist if you:

  • have had an allergic reaction to paracetamol or any other medicines in the past

  • have liver or kidney problems

  • regularly drink more than the maximum recommended amount of alcohol (14 units a week)

  • take medicine for epilepsy

  • take medicine for tuberculosis (TB)

  • take the blood-thinner warfarin and you may need to take paracetamol regularly

Unlike acetaminophen, ibuprofen acts as an anti-inflammatory drug, which means it reduces inflammation and swelling. However, it also offers other benefits. “Ibuprofen is a non-steroid, anti-inflammatory. In other words, it reduces inflammation and pain in the body, and it can also be used as a fever reducer,” Reeder says. Some common brand names of ibuprofen include Advil and Motrin.


Types of NSAIDs


NSAIDs are available as tablets, capsules, suppositories (capsules inserted into the bottom), creams, gels, and injections.


Some can be bought over the counter from pharmacies, while others need a prescription.

The main types of NSAIDs include:

They're all similarly effective, although you may find a particular one works best for you.


Who can take NSAIDs?


Most people can take NSAIDs, but some people need to be careful about taking them.


It's a good idea to ask a pharmacist or doctor for advice before taking an NSAID if you:

  • are over 65 years of age

  • are pregnant or trying for a baby

  • are breastfeeding

  • have asthma

  • have had an allergic reaction to NSAIDs in the past

  • have had stomach ulcers in the past

  • have any problems with your heart, liver, kidneys, blood pressure, circulation or bowels

  • are taking other medicines

  • are looking for medicine for a child under 16 (do not give any medicine that contains aspirin to children under 16)

NSAIDs might not necessarily need to be avoided in these cases, but they should only be used on the advice of a healthcare professional as there may be a higher risk of side effects.


If NSAIDs are not suitable, your pharmacist or doctor may suggest alternatives to NSAIDs, such as paracetamol.


Summary


There are few health complaints more common than a headache. In a given year, half of Americans will experience at least once. But it is still one of the most underdiagnosed and undertreated medical conditions, in part because cause and effect can be jumbled. For most headaches, doctors have not yet pinpointed the cause.


One headache can ruin your day. Frequent or severe headaches can be a never-ending nightmare. Whichever headache type you have, you might be wondering how best to treat your symptoms.

The goal of acute headache treatment is consistent, fast, and complete relief of symptoms with reduced disability and without headache recurrence. This makes it important to match the treatment to the level of disability to gain the best possible relief and prompt return to function.


Headache may need to be managed with medications. Symptomatic relief relieves symptoms associated with headaches. Abortive therapy stops the process that causes the headache. Preventive therapy prevents headaches. Nonprescription pain relievers have been demonstrated to be safe when used as directed.


Medications used to treat headache can be grouped into three different types:

  • Symptomatic relief

  • Abortive therapy

  • reventive therapy

Each type of medication is most effective when used in combination with other recommendations, such as dietary modifications, lifestyle changes (at least 7-8 hours of sleep and adequate hydration [6-8 glasses of water/day], exercise and relaxation therapy).


For decades, a daily dose of aspirin was considered an easy way to prevent a heart attack, stroke, or other cardiovascular events. Then came a string of recent studies challenging that assumption. With this latest research in mind, a new set of guidelines to help people stay heart-healthy is advising against daily aspirin use for prevention. It may cause more harm than good.


If you don't have heart disease but do have high blood pressure or other risk factors, don't automatically assume daily aspirin is a good idea. "A lot of people take aspirin who really shouldn't," says Dr. Christopher Cannon, a cardiologist at Brigham and Women's Hospital and professor of medicine at Harvard Medical School. "Everyone assumes aspirin is harmless, but it's not." For some, the downsides of aspirin—mainly gastrointestinal bleeding—outweigh its benefits.

Most of the low-dose aspirin sold in the United States is enteric-coated (sometimes called safety-coated). The coating allows the aspirin to pass through the stomach to the intestine before fully dissolving. That is supposed to lessen stomach upset, but in reality, aspirin still affects the entire digestive tract via the bloodstream.


"Enteric-coated aspirin does not decrease the risk of gastrointestinal bleeding compared with uncoated aspirin," says digestive disease expert Dr. Loren Laine, a professor of medicine at Yale University. The same is true for so-called buffered aspirin, which combines an antacid such as calcium carbonate (found in Tums) or aluminum hydroxide (found in Maalox) with aspirin.

Previous guidelines from the United States Preventive Services Task Force warned against taking aspirin for the primary prevention of heart disease unless you’re at elevated risk — typically if you’re 50 to 69 years old with a 10 percent or greater chance of having a heart attack or stroke within the next 10 years.


“There is good reason to be wary of aspirin”, warns Michos, particularly for women. The Women’s Health Study was a large trial that looked at whether women with no history of heart disease would benefit from taking a low dose of aspirin. Researchers found that in the overall group of women, aspirin didn’t reduce the risk of heart attacks, but it did increase the risk of bleeding. Some benefit was seen for women over the age of 65.


It’s important for people to realize that just because aspirin is over-the-counter does not mean it is necessarily safe”, says Michos.


Disclaimer


This article is written in goodwill to inform the readers about the potentially harmful effects of widespread use of aspirin around the world. It is a review of the literature (sources given below), for more information, consult your physician for proper use of any drug, including aspirin.


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