As of Tuesday, January 7, 2014
DEAR DOCTOR K: I have cirrhosis of the liver. I also get tension headaches. What pain reliever can I take for my tension headaches?
DEAR READER: One of the liver’s many jobs is detoxification — ridding the blood of toxins. Cirrhosis, a liver disease, interferes with the liver’s ability to detoxify substances in the blood.
Your liver sees medications as toxins. When your liver is compromised, medications that are normally considered “safe” may no longer be safe for you.
The safest pain medicine for someone with cirrhosis is acetaminophen (Tylenol). However, even this is more risky in people with cirrhosis. That’s because this medicine can be toxic to the liver. There is some evidence that it may be more likely to injure a liver already damaged, such as from cirrhosis.
I advise patients with cirrhosis not to take more than 2,000 milligrams (mg) in one day, or more than 650 mg per dose. That’s the equivalent of two regular-strength acetaminophen tablets. Take acetaminophen for the shortest time as possible. Some doctors believe it’s OK for people with cirrhosis to take as much as 3,000 milligrams (mg) in one day, but I’m more conservative.
Another frequently used non-prescription class of painkillers is the non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Unfortunately, cirrhosis raises the risk of internal bleeding from NSAIDs. Also, cirrhosis makes the kidneys more vulnerable to injury from drugs, particularly NSAIDs. So I think it’s best for people with cirrhosis to avoid NSAIDs.
When possible, use non-drug strategies to relieve pain. Here are some:
— Ice or heat, and rest. Numb the pain with an ice pack, wrapped in a towel and applied to your forehead and temples for 15 minutes at a time. If muscle tension accompanies your head pain, apply heat packs to your neck and the back of your head. Retreating to a dark, quiet room to rest can also help.
— Tai chi and yoga appear to reduce headache frequency and severity. But they don’t help relieve a headache once it has begun.
— Acupuncture involves inserting fine needles into the skin. This may release endorphins, the body’s natural painkilling chemicals.
— Biofeedback. Head pain is often triggered by muscle tension. During biofeedback sessions you’ll learn to recognize when you’re tensing up the muscles in the back, neck, shoulders or head — and to relax them before they cause pain. Biofeedback treats and prevents tension headaches.
— Massage. I’ve had several patients who have found that massage of the muscles in the back of the neck gave them relief, though I know of no studies proving its value.
Finally, avoid situations that seem to bring on your tension headaches, such as working at a computer uninterrupted for several hours, or arguments with your children.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.