Am I ruining my liver?

I often take painkillers (acetaminophen aka paracetamol), but I've noticed that it's much more effective if I take them TOGETHER with my ADHD medication (ritalin aka methylphenidate) + my morning coffee. If I don't take them AT the same time, the painkiller is far less effective.

I do not exceed the maximum dosage of painkiller (1gram per intake, mornings), but alone this would barely suffice to kill my morning headache.

My hypothesis is that since the LIVER has to convert all three, I am effectively overdosing on either substance (painkiller or ADHD meds), and damaging my liver in the process.

Tehdastehdas ,
@Tehdastehdas@lemmy.world avatar

The liver has different enzymes to break different molecules, so those drugs might all use different ones, not slowing down the breakdown of others. I didn't check. Wikipedia usually tells drug metabolism in detail.

dysprosium OP ,

Good point. I'll check. Though I'm not sure if that is the only point of relevance. What if the overal 'output' of the liver is still exceeded? Aka it's just working overtime producing those different enzymes.

Whorehoarder ,

Btw, we're all gonna want an update if you figure it out. I'm invested now

dysprosium OP ,

I'll try. Don't think it will have a happy ending though

011000010111001101110011 ,

Two things:

  1. Generally when you take medicine with high acidity food, like coffee, it will break down your medicine prematurely - you won't get as strong as an effect. I had to stop taking my Vyvanse with orange juice because it basically nullified the medicine.

  2. Talk to your doctor. I had chronic headaches that I found out were related to low blood pressure and dehydration. Drinking water instead of diuretics, like coffee, immensely helped me.

Wahots ,
@Wahots@pawb.social avatar

Talk to your doctor, do not get medical advice from the internet, it is too risky.

Iheartcheese ,
@Iheartcheese@lemmy.world avatar

Counterpoint: Do more drugs the internet says so.

troed ,
@troed@fedia.io avatar

Many countries have lowered the max dosage of Paracetamol from 1000mg since there's indeed a worry that it will cause liver damage. I'm in one of the countries that still go with 1000 (Sweden) and my suggestion would be to use 500mg Paracetamol and 400mg Ibuprofen taken together instead. That's what the medical professionals themselves do.

That said, something in your life is causing you to have morning headaches and it's a better idea to fix that. Regular painkiller usage is one of the things that causes it (!). Other possibilities can be waking up during the wrong sleep cycle (deep vs light), sleep apnea causing bad sleep in general, overdosing on caffeine causing withdrawal symptoms in the morning etc.

/Not a medical professional

Today ,

It's shockingly easy to OD on acetaminophen. I don't think you are; i just think it's interesting how a few Tylenol plus a couple doses of cold medicine can be serious.

KittenBiscuits ,

Long time headache adventurer here.

You are basically making a homemade Excedrin (acetaminophen + aspirin + caffeine). Stimulants cause your body to metabolize the pain reliever more quickly.

As for if you're ruining your liver, I can't say, other than you should probably go see you doctor and ask for a blood panel/ liver function test. Even if your liver values are normal, you'll know for sure, and have a baseline to compare future tests against. Plus your doctor may have some thoughts on why you're having a headache everyday.

For me it turned out that while i had acceptable blood pressure, it was high "for me", and a beta blocker took care of the most frequent headaches. But we didn't figure that out until we had ruled out a whole bunch of other things.

It was a frustrating journey to be sure. I wish you luck in yours.

tiredofsametab ,

Wrong question, I would argue. If you have a morning headache, you should really find the root of that and try to resolve it making the medication unnecessary.

dysprosium OP ,

I know, but I've headaches since I was about 10 (now almost ~30), and the only causes for this that I can seriously come up with is: being sensitive af in general, which then leads to being (subconsciously) easily stressed, which then, results in headache. This happens during the day, but I also (more) frequently wake up with a headache for no reason. This even happens in the summer, when I'm not doing ANYthing (no school, university, work). I am generally perfectly healthy. I am hydrated, eat healthy, etc. I don't exercise an awful lot, but when I do (for months), I barely notice any difference.

Being "sensitive" (whatever that means exactly) is the only weird but plausible explanation. Reading the other comments, though, like sleep apnea, I'm curious if that's anything...

liam070 ,
@liam070@sopuli.xyz avatar

But did you talk about it with a medical trained person ? In the end its just a damaged nerve in your neck or sonething that can be easily fixed with proper care.

dysprosium OP ,

I did many times but most of the time I was just advised to "try eating and sleeping better" which I kind of already did, but improving those did not make a difference whatsoever. I also went to many physiotherapists and one manual orthopedic doctor. Nothing was ever improved.

Except one time when I went to a acupuncturist who also added some spiritual woo, and that actually remedied a part of it.

Lumisal ,

That combined with what you mentioned about cannabis triggering your headache sounds like the issue might be your trigeminal nerve (my guess mylohyoid) or similar nerve branch in the neck area. Sleeping likely causes it because there's constant pressure on it at night as you sleep.

An orthopedic pillow might help, something such as this for example:
https://www.amazon.com/Osteo-Cervical-Odorless-Adjustable-Orthopedic/dp/B09964WTF5?th=1&psc=1

Alternative hypothesis would be it's blood pressure related, perhaps orthostatic hypotension or fluctuating hypertension - you can test this by getting a good blood pressure machine and checking in the morning before you get up from bed without moving much, immediately after sitting up, immediately after standing, and then stay standing still for 1 minute and take again.

Probably don't need the coffee by the way considering the medicine you take (Ritalin)

dysprosium OP ,

Wow interesting! I'll be saving for a pillow like this. I thought about measuring blood pressure in the morning, as well. But I doubt these things come cheap. I'm curious though how you linked cannabis is causing headache to, nerves in my neck area might be causing headaches. I've been cooking up a lot of potential (intermediate) causes, but nothing like this.

Lumisal ,

Trigeminal nerve pain can be triggered/worsened by an enlarged vein pushing against the nerve at just the right spot. Cannabis causes hypotension via vasodilation, hence the potential trigger.

The thing is, veins don't grow perfectly parallel, which means hypertension can also cause pain via vasoconstriction, if the vein slightly spirals around the nerve and also constricts; think like a snake wrapped around an arm and squeezing. So it's possible both localized vasodilation and vasoconstriction are causing these headaches, considering the times the headache is worst ("cannabis use or after waking up) and mild but constant (after stimulants like caffeine).

If your pressure is a bit high during the day, a very small dose of a vasodilator drug taken after your medication would normalize it and that would, hopefully, stop the pain overall. You could still have orthostatic blood pressure issues too, but certain mild exercises can help with those too (assuming there's no other underlying blood flow issues).

But there's not enough data to say conclusively, hence taking your blood pressure as directed, as well as throughout the day sitting (after sitting at least 3 minutes without moving much) to see if there's any abnormalities with it, as well as the orthopedic pillow. If the pillow helps it also narrows down the cause.

That said, if it's the trigeminal nerve and you can't control the veins there well through medication... Good luck I suppose. Most surgeons won't want to cauterize because of mild (yet constant) pain. Acupuncture could achieve the same result, but that would be a scary gamble, because there's also potential they hit the nerve wrong with the micro needle and instead worsen the pain. That would be a last result solution, assuming it's the trigeminal nerve causing you issues.

Lumisal ,

Forgot to mention, don't know where you live, but Omron makes good enough yet affordable blood pressure machines. Just don't ever get anything for the wrist.

volvoxvsmarla ,

Ok, follow up question. If you don't take a painkiller in the morning, how does the headache progress?

dysprosium OP ,

Usually it will not go away the whole day. Only in the evening that it starts to subside. And when I decide to take it, I need to do it in a specific way. E.g. direct lying extremely comfortably, but not sleeping, or it won't be as effective. Or drinking coffee in front of my pc. And a few other ones. I don't get why but I usually just feel what specific 'ritual' works best for any given moment. Sometimes I guess wrong and the headache won't disappear. This combination with coffee and adhd med seems to work best though.

hayreddin ,

Another hypothesis is bruxism (teeth grinding). Some people have it during the day, others (like me) have it during sleep. Stress and anxiety makes it worse. I only discovered I had it because people heard me biting my teeth against each other while asleep. I went to a dentist, she made me a mouth guard that I use every night before going to sleep, and the morning headaches stopped since then.

dysprosium OP ,

I tried this as well. I bought a (DIY) mouth guard. Did not do much if anything, unfortunately.

This was at the same time I heard about injecting botox in your head skin and jaw to relax muscles. Sounds weird but worth a try

RBWells ,

Migraines come during sleep like that, but if Paracetamol works no way is it a migraine. That stuff literally does nothing for any pain I've had, ever.

I agree with everyone here, this seems like a lifestyle thing - if your body is indeed sensitive to stress and relaxation, you are not doing it any favors with the paracetamol. Likely too stressed in day, too relaxed at night, the sudden change a trigger. Obviously you don't want to fix that by being tense while asleep, so tackling the day stress responses make more sense. Do you exercise?

What happens if you just have either coffee or the Adderall in the morning, without the painkiller drug?

dysprosium OP ,

What happens if you just have either coffee or the Adderall in the morning, without the painkiller drug?

Not tested excessively, but quite sure it's not relieving the headache whatsoever.

I do not exercise. Usually I cycle to uni about 40mins a day, 4 times a week. I've exercised more rigorously in the past, running each day, but the effect is not significant... So unfortunate. But exercise is quite wearisome

RBWells ,

Have you seen a neurologist or headache specialist or only a GP? If there is a cause maybe it can be treated and you can find relief. I do get migraines, but not every day, not even every week. My other guess is allergies, but in any event, keep a good record of what you are doing and feeling, and bring the information to a doctor! I don't think it's wrong at all to post and ask though, you get more ideas and that will help.

Running doesn't help me as much as a vigorous yoga class, the "flow" kind that is more athletic and movement based, then moves to static poses at the end. Or dancing, that works too. The cycling sounds like enough, honestly, anything that is regular and kind of exhausting, will relax your mind.

dysprosium OP ,

Only a general practitioner (a general doctor, right?). Although, no headache specialist, I have visited some people, like many physiotherapists, one manual orthopedic doctor, and one acupuncturist.

Yep, I try to record my input and output to some extend. My 'journal' up til now is really weird, vague, and incomplete. I can probably try a kind of (mentally) relaxing exercise but honestly don't know what. Something like yoga indeed, but not sure if exactly that is something for me.

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