When confronted with a headache, a muscle spasm or menstrual cramps, many people reach for the nearest aspirin or over the counter (OTC) non aspirin pain reliever. While these drugs are interchangeable for certain ailments, each has distinct physiological effects that makes them more appropriate treatments for certain ailments and under certain circumstances.

Aspirin and OTC non aspirin pain relievers are broadly divided into two groups, non-steroidal, anti-inflammatory drugs (NSAIDs) and acetaminophen. In addition, some OTC drugs contain a combination of these pain relievers. Here is a list of the most common OTC pain relievers, some history and their effects and uses.


Aspirin (Bayer, Anacin, St. Joseph‘s)

Technically known as acetylsalicylic acid, aspirin has been used as a painkiller, fever reducer and anti-inflammatory agent for well over a century. Today, it is one of the most widely used pain relievers in every country of the world. Though classified as a NSAID, aspirin works in a different way and with more permanent results than the others.

Aspirin is most often prescribed for the relief of dull, throbbing pain common with tension or  migraine headaches, for post-surgery pain and for the reduction of fever due to colds. Interestingly, many manufacturers of aspirin include caffeine in their formulation as the combination of the two has a significantly greater effect.

It is not recommended that aspirin be taken in high doses for an extended period of time as complications such as gastrointestinal hemorrhages may occur. Though not an analgesic therapy, taking aspirin in low doses for an extended period is often recommended to reduce the risk of heart attack. Obviously, a physician can explain and advise as to the best course of action in those circumstances.


Acetaminophen (Tylenol, Uniserts)

Acetaminophen is widely called Tylenol in the United States but it is known throughout the rest of the world as paracetamol. In either case, it is another widely prescribed pain reliever for headaches and for fever reduction. In addition, and unlike aspirin, it is also remarkably effective in the treatment of muscle pains. It is not an NSAID as it only demonstrates a very weak anti-inflammatory action.

First tried on patients in the last quarter of the 19th century, paracetamol was quickly overshadowed by the efforts of the Bayer drug company which introduced two other pain relievers phenacetin and aspirin. It would be another 50 years before acetaminophen would become widely accepted as a safe and reliable pain reliever.

These days, the drug is widely prescribed for arthritis and other chronic conditions since acetaminophen can be taken for extended periods of time. There are almost no side effects associated with long term use.

One exception is that alcohol should not be consumed with acetaminophen and that heavy drinkers should not engage in a paracetamol regimen as the combination of the two can cause severe liver damage. This fact cannot be overstated as acetaminophen overdose is the leading cause of acute liver failure in the United States. As usual, a doctor should be consulted about any unusual or extenuating medical circumstances in which acetaminophen will be taken.


Ibuprofen (Advil, Motrin, Nuprin)

Ibuprofen is an NSAID used in the treatment of mild headaches, menstrual cramps and muscle aches as well as tenderness and swelling in the joints. It has a significantly greater anti-inflammatory effect than either aspirin or acetaminophen. In fact, prescription strength ibuprofen is often used to relieve many of the symptoms of both osteoarthritis and rheumatoid arthritis. Also, unlike its two main competitors, ibuprofen is stable in solution and can be made into a topical gel that can be directly applied to affected muscles or joints.

A relative latecomer to the game, Ibuprofen was first synthesized by the pharmaceutical subsidiary of the British company, Boots Group, in the early 1960s. Upon introduction , the drug was by prescription only but, in the decade that followed, Ibuprofen’s broad tolerability and its evident efficacy led to  its release as an OTC drug. Today, Ibuprofen is the most recommended OTC drug for both menstrual cramps and for arthritis like symptoms.


Naproxen (Aleve, Naprosyn)

Due to its relatively late arrival on the pain relieving scene, Naproxen is the only drug on this list not included in the World Health Organization’s list of essential drugs. First developed in the late 1970s, it is still prescription only in many parts of the world.

Naproxen is also an NSAID and is, like the other, most usually prescribed as a pain reliever, fever reducer and anti-inflammatory agent. It is often prescribed for heart patients in lieu of Ibuprofen due to its lessened, associated risk for stroke and myocardial infarctions.


Combination Drugs (Vanquish, Midol, Excedrin Xtra Strength )

As mentioned, some manufacturers have chosen to combine the benefits of two or more of these drugs in the same package. The directions on the package should be followed closely as the misuse of any combination of drugs can easily lead to severe consequences.

Three of the more notable examples of these combination OTC drugs are:


This OTC drug combines aspirin, acetaminophen and caffeine to purportedly cover all the bases. Vanquish is a strong analgesic and fever reducer with some anti-inflammatory properties. Due to its broad based effects, Vanquish should not be taken with any other drug or alcohol unless by doctor’s orders.



The brand name Midol has become synonymous with pain relief for menstrual cramps. The manufacturers, however, have introduced a whole panoply of products that combine every one of the drugs listed above except aspirin with various diuretics, antihistamines, stimulants or sleep aids. It is extremely important to read the package so as to understand the exact mix of drugs that you are buying.



Developed by Bristol Myers Squibb and now owned by Novartis, the Excedrin line of pain relievers combines the best ideas of both Vanquish and Midol. The manufacturers employ every combination of aspirin, acetaminophen, decongestants, sleep aids, caffeine and other less ingredients to produce “multi-ingredient headache relief.” Again, close attention should be paid to the exact ingredients and their effects when mixed with prescription drugs or alcohol.


The Final Analysis

The use of aspirin or  OTC non aspirin pain relievers has proven to be safe and dependable. Constant reliance on them, however, can lead to a diminished efficacy and to other health related problems. Avoid a scattershot approach that tries everything until a solution is found. Instead, be sure to take the most appropriate medicine for your particular ailment.