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Viagra and generic Viagra (Sildenafil) are essentially the same medicine in that they contain exactly the same active ingredient: sildenafil citrate. Headache and back pain are thought to be caused by changes in blood flow and muscle relaxation. Due to this, doctors will ask for regular check-ups and may adjust the dose if a person has any side effects. The dose depends on your response and age. What strength would you prefer? Avoid taking sildenafil with any other ED medications.