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Headache Care

Frequent migraines, period cramps

Tuesday, May 18 2010


Q. I get bad migraines and menstrual cramps frequently. I usually take two Panadol Extra and another two a couple of hours later if the pain does not subside. This happens at least once a week.

At other times, I take two paracetamol tablets every four hours till there is no more pain (which may last up to three days). Doctors have also given me muscle relaxants but these cause me to feel drowsy. I cannot afford to be drowsy at work.

What can I do to counter this paracetamol build-up in my body? How can I control the pain?


I assume that the diagnoses you have mentioned are based on proper medical assessment. Your general practitioner should be able to decide if you need further referrals to either the neurologist for your migraine or the gynaecologist for your menstrual cramps. The recommended dose for paracetamol for an average healthy adult is two tablets (500mg per tablet) per dose, up to four times a day, preferably four to six hours apart.

In other words, you should not take more than eight tablets (or 4g) over a 24-hour period. Doing so risks paracetamol toxicity which can be life threatening. Otherwise, if you follow the recommended dosage, it is a safe analgesic and there should be no issues with paracetamol build-up, since your body will process and remove the drug.

However, do note that Panadol Extra is a combination drug and usually contains a separate drug constituent besides Panadol. Hence, it is important to know your analgesics so that you can use them in a safe manner.

Some analgesics like non-steroidal anti-inflammatory drugs (for example, mefenamic acid and naproxen) may cause less drowsiness. These may be effective for both migraine and menstrual cramps.

Other measures for managing migraine include avoiding triggers (for example, stress, lack of sleep and certain foods), preventive treatment with drugs (for example, beta-blockers, tricyclic antidepressants and anticonvulsants), using non-drug techniques (for example, relaxation, stress management and massage) and special anti-migraine drugs (for example, cafergot and triptans).

For menstrual cramps, using analgesics early may be helpful in preventing the pain from worsening. The use of hot packs can also be useful and is generally safe.

Dr Poon Keah How

Dr Poon Keah How is a consultant at the department of anasthesia at the National University Hospital.


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