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May acetaminophen and/or ibuprofen be administered to patients with headaches

Question# 760

Can acetaminophen and ibuprofen be given to patients to treat headaches, assuming they meet the other aspects of the directives? I’ve been told by colleagues that even PCP scope analgesia used specifically for headaches isn’t allowed, but I never interpreted the directive this way, so just looking for some clarification.


Yes, acetaminophen and/or ibuprofen may be administered to patients with headaches.

The Analgesia Medical Directive has only one indication, pain; and only one type of pain is excluded for acetaminophen and NSAIDS (ibuprofen & ketorolac): ischemic chest pain. The directive does exclude headache only for the opioids (morphine & fentanyl). The Companion Document does not touch on headache. Therefore, we can feel comfortable that acetaminophen and/or NSAIDS (ibuprofen & ketorolac) may be administered for a headache. In fact, acetaminophen and ibuprofen are very effective against headaches, and are the first line treatments for them.

Across the RPPEO region, and in healthcare in general, we tend to under-treat pain. It is best practice to offer analgesia to all patients in pain as long as it's appropriate and the indications/contraindications are satisfied. The World Health Organization has gone so far as to suggest analgesia is a fundamental human right.

The only caution is to consider the risk of a brain bleed as the cause of the headache, and if suspected only administer acetaminophen and not NSAIDs. Brain bleeds may be suspected in thunderclap headaches, if related to head trauma, minor head trauma within the past two weeks in persons at elevated risk of subdural hematoma, and suspected stroke.


UpToDate (
* Evaluation of the adult with nontraumatic headache in the emergency department
* Overview of thunderclap headache
* Stroke: Etiology, classification, and epidemiology
* Subdural hematoma in adults: Etiology, clinical features, and diagnosis

Austin, M, 2021. Pain – To Treat or Not to Treat, that is NOT the question! MedicNEWS.

World Health Assembly:


30 January 2024

ALSPCS Version




Please reference the MOST RECENT ALS PCS for updates and changes to these directives.