Date Published

March 28, 2019

Updated For

ALS PCS Version ALS PCS Version 5.2


Are we allowed to give acetaminophen and ibuprofen to someone who has a headache under the pain directive? I had 2 different patients not too long ago and both were complaining of a headache. One patient just ended up having just a headache while the other patient whom had a headache over several days with no facial droop, slurred speech, equal pupils and equal bilateral grip strengths turned out to be a bleed. Would it be ok to just give acetaminophen to our patients complaining of a headache and hold off on the ibuprofen? Headache is not a contraindication for the pain directive so this is why I am asking.


You are correct that neither acetaminophen nor ibuprofen carry the strict administration Contraindication of Treatment of headache that the opioids Morphine and Fentanyl have under the new AUXILIARY Analgesia Medical Directive. As you eloquently point out with your examples, headache can be due to both benign and serious causes, including CVA/ intracranial bleed. As, CVA or TBI in the previous 24 hours is a Contraindication to ibuprofen administration, it would be pertinent to withhold treatment if the patient exhibits an abnormal neurological exam (as expected with a stroke/bleed) or you have significant concern that the cause of the headache may be due to a CVA or TBI. However, the patient you describe, above, did not have any of these overt symptoms and therefore it would be reasonable to administer both acetaminophen and ibuprofen. As previously stated in ASK MAC (Dec 20, 2013), and written into the pre-amble of the ALS-PCS v4.5, the word consider is used repeatedly throughout the Medical Directives. Where this word appears, it indicates that a paramedic should initiate treatment unless there is a strong clinical rationale to withhold it. A paramedic must document his or her justification for withholding treatment on the ACR. Therefore, should you have rationale to withhold medication, please make sure to document your rationale. Please note that a patch to the BHP can be considered for direction when there is uncertainty on how to proceed.



Auxiliary Analgesia

Additional Resources

No additional resources are available for this SWORBHP Tip.