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 strategies you can try when you experience a tension headache:
— 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.