Using Excedrin to Treat Migraine and Headaches

Most people turn to an over-the-counter medication when they are experiencing an acute migraine attack or tension-type headache. This is sensible, as over-the-counter medications like Tylenol (acetaminophen) and nonsteroidal anti-inflammatories (NSAIDs), like ibuprofen and aspirin, are easily available, cheap, and do not require a healthcare provider's visit. Even more, there are scientific studies supporting their benefit and safety in treating an episodic migraine or tension-type headache.

Woman laying on couch with headache
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That said, when perusing the aisle of your local pharmacy, you have likely noticed another over-the-counter pain reliever for migraines and tension headaches—Excedrin. It's a combination analgesic that contains Tylenol (acetaminophen), aspirin, and the "eye-opening" agent caffeine.

With that, you may wonder whether Excedrin is as good (or even better) than Tylenol alone, aspirin alone, or ibuprofen alone for alleviating headaches and migraines.

Let's explore this question in a bit more detail, as the answer is not as straightforward as you may expect. In other words, there are upsides and downsides to consider when choosing Excedrin as your "go-to" medication for tension headaches or migraines.

  • Caffeine increases the effects of analgesics

  • Caffeine has stimulant effects

  • Caffeine increases gastric motility, which can be slowed during a migraine attack.

  • Caffeine has side effects

  • Caffeine can lead chronic migraines

  • Caffeine withdrawal can trigger headaches

The Upside

In a review study in The Journal of Headache and Pain, the combination of caffeine with an analgesic like Tylenol (acetaminophen), aspirin (acetylsalicylic acid), and ibuprofen, was more effective in treating migraines and tension-type headaches, as compared to the analgesic medication alone.

However, you may be surprised to learn that caffeine, itself, is not a pain reliever. Rather, it increases the effect of analgesics, like aspirin and Tylenol, and it does this by enhancing their absorption within the gut.

Research shows caffeine's augmenting effect is seen at doses of 130 milligrams (mg) or more in tension-type headaches and 100 mg or more in migraine. Since over-the-counter caffeine-containing medications contain 64 to 65 mg of caffeine (including Excedrin), please note that you would have to take two Excedrin tablets to derive the caffeine benefit (which is a typical dose).

As an added bonus, it's worth mentioning that a caffeine-containing headache pain reliever may have other perks. Caffeine is a stimulant, meaning it improves mood, alertness, information processing, awareness, attention, and reaction time. So if you feel particularly fatigued or sluggish with your headache, Excedrin may not only soothe your pain but help you feel more energized.

Additionally, caffeine improves gastric motility (the physical movement of food through your digestive tract). This may be especially helpful for migraineurs, as gastric motility can be reduced during a migraine attack, leading to nausea and/or vomiting.

The Downside

Medical care is generally not black and white. In other words, it's a complex art, as not every person's body and medical history are the same. To ensure a specific medication is right for you, it's important to first talk with your healthcare provider.

Side Effects: One downside of taking Excedrin instead of Tylenol, aspirin, or ibuprofen alone is that you may experience side effects from the caffeine. The most common side effects are:

  • Upset stomach
  • Heart palpitations
  • Dizziness
  • Nervousness
  • Nausea

That said, these side effects are generally mild and short-lived. Still, if you normally cannot tolerate a strong cup of coffee or are about to go into a meeting and are worried about getting a bit shaky, Excedrin may not the best choice for you at that time.

Caffeine Paradox: Caffeine in the moment, if you are not taking it regularly, can be helpful in getting rid of a headache.However, if you are used to a certain amount everyday, like a cup of coffee in the morning, abruptly changing that pattern can cause a withdrawal headache.

Too much caffeine with pain medications, can lead to desensitization in the brain, which means that your body will get used to it and need higher doses to achieve same effect. This can lead to more headaches over time.

Furthermore, caffeine withdrawal can trigger headaches as well as lead to a decrease in cognitive function, nausea, and vomiting (all in the short-term). Although, in the long-term, (and not to complicate the picture), caffeine cessation is likely beneficial for people with headaches.

If you are sensitive to caffeine, incorporating Excedrin into your routine may not be the best "go-to" headache option for you.

See Your Primary Care Doctor

It's best to come up with a plan with your primary care doctor or headache specialist concerning which over-the-counter medication you may take if you develop a headache. This is because even though Tylenol, Excedrin, and NSAIDs are available without a prescription, they are not safe for everyone.

While not an exhaustive review, here are some examples of the concerns associated with these over-the-counter medications.

NSAIDs (Including Aspirin or Aspirin-Containing): NSAIDs can cause stomach irritation and bleed so should not be used by people on blood-thinning medications or by people with a history of stomach ulcers.

Moreover, people with certain medical problems (e.g., asthma, or kidney, heart, or liver problems) should either not take NSAIDs or should be very closely monitored by their healthcare provider while taking one.

Aspirin or aspirin-containing products (like Excedrin), should never be given to children, as they can increase a child's risk for developing a serious illness called Reye's syndrome.

Tylenol (Including Tylenol-Containing Medications): Many over-the-counter medications contain Tylenol (acetaminophen), like cold medicines and of course, Excedrin. With that, a person can overdose on Tylenol unintentionally, and this can lead to liver failure.

All Over-the-Counter Medications: Over-the-counter medications may interact with your prescription medications. This is why it's essential to inform your healthcare provider of all the medications you are taking, including any vitamins or supplements.

A Word From Verywell

While research shows caffeine-containing analgesics like Excedrin are more effective in easing migraines and tension-type headaches than taking Tylenol, aspirin, or ibuprofen alone, that may not be the case for you as an individual.

Lastly, regardless of the over-the-counter medication you use, be careful to limit it to less than two to three days per week. This way you can avoid a medication overuse headache, which is when a person develops rebound headaches—a double whammy, and a problem that is particularly tricky to treat.

If headaches are ongoing, speak to your healthcare provider to get the most accurate diagnosis and treatment for you particular symptoms.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K. Caffeine in the management of patients with headache. J Headache Pain. 2017;18(1):107. doi:10.1186/s10194-017-0806-2.

  2. Institute of Medicine (US) Committee on Military Nutrition Research. Marriott BM. Food components to enhance performance: an evaluation of potential performance-enhancing food components for operational rations. Washington DC: National Academies Press. 

  3. Aurora SK, Papapetropoulos S, Kori SH, Kedar A, Abell TL. Gastric stasis in migraineurs: etiology, characteristics, and clinical and therapeutic implications. Cephalalgia. 2013;33(6):408-15. doi:10.1177/0333102412473371.

  4. MedlinePlus. Caffeine.

  5. American Migraine Association. Caffeine and migraine.

  6. Soleimanpour M, Imani F, Safari S, et al. The role of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of patients with hepatic disease: a review article. Anesth Pain Med. 2016;6(4):e37822. doi:10.5812/aapm.37822. 

  7. U.S. Food and Drug Administration. Acetaminophen: avoiding liver injury.

  8. American Migraine Foundation. Headache from medication overuse.

Additional Reading

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.