Over-the-Counter Medications for Migraine or Tension Headaches

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Tension headaches and migraines are fairly common, and most people who experience them try over-the-counter (OTC) medications before talking to their doctor about prescription options. It is a good idea to try these less powerful options first, as non-prescription medications often relieve the symptoms of migraines and other types of headaches with fewer side effects than prescription-strength drugs.

Another benefit of over-the-counter medications, of course, is that you can get them whenever you need them. But it's important that you talk to your doctor about your headaches just to make sure you don't have another medical condition that may require treatment of another kind. Also be sure to run any OTC drugs you intend to take by your doctor or pharmacist to ensure that they are safe for you and won't pose any drug or supplement interactions.

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Tylenol (acetaminophen)

Tylenol (acetaminophen) is a common choice for alleviating tension headaches. While it is not commonly used for the treatment of migraines, studies show that when Tylenol is combined with an anti-nausea medication like Reglan (metoclopramide), the combination is as effective as sumatriptan—a prescription medicine for treating migraines. 

Acetaminophen is a very well-tolerated medication, making it a good alternative if you can't take nonsteroidal anti-inflammatories (NSAIDs). The maximum daily dose is six pills per day (3,000 milligrams), and it should be taken at an interval of two pills every six hours.  

It's important to note that the leading cause of liver failure in the western world is misuse or overdose of acetaminophen. Prolonged use can cause liver or kidney damage and may be life-threatening, and it should never be mixed with alcohol. If you have liver disease, check with your doctor or healthcare professional before taking acetaminophen.

Keep in mind that acetaminophen is present in some combination pain medications, like Excedrin, Percocet, and Vicodin. Be sure to consider the total amount of acetaminophen that you are taking from all sources if you use these medications.

Advil, Motrin (ibuprofen)

Ibuprofen is often used for the treatment of tension headaches, as well as mild to moderate migraines. It is an NSAID, which means that it works by reducing pain and inflammation.

In certain circumstances, ibuprofen can be slightly more effective and works faster than acetaminophen for headache relief. For both Advil and Motrin, the maximum daily dose is six pills per day (1,200 milligrams), and it should be taken at an interval of one pill every four to six hours.

Ibuprofen can cause stomach upset and may increase the risk of bleeding. Easy bruising, slow healing, nose bleeds, dark stools, spitting up blood, and red or pink urine are all signs of bleeding. You should not use this medication if you have kidney or heart disease, or a history of stomach bleeding. 

Aleve (naproxen) 

Like ibuprofen, naproxen is an NSAID. It works in the same way and carries the same risks as ibuprofen. Naproxen can reduce the symptoms of tension headache, but it is not considered clinically useful for migraine treatment when used alone.

When combined with sumatriptan, however, it provides more relief than either sumatriptan or naproxen alone, and you may be able to take a lower dose of sumatriptan if you use naproxen along with it. This can help you avoid the side effects of sumatriptan and can help prevent refractory migraines.

For Aleve, the maximum daily dose is 660 milligrams per day taken at an interval of one pill every eight to twelve hours, and no more than three pills should be taken in a span of 24 hours.

Ecotrin, Bufferin, Ascriptin (aspirin)

While it has lost some popularity in recent years, aspirin is still among the most commonly used NSAIDs, particularly among older individuals. Aspirin has several mechanisms that make it an anti-inflammatory, a blood thinner, and a pain reliever.

It is often effective in reducing the symptoms of migraines and tension headaches, but aspirin is more likely to cause bleeding than other blood thinners and can also cause other side effects, including a rash or ringing in the ears. Aspirin may also cause a severe allergic reaction, which manifests with facial swelling and breathing difficulties.

Because of the side effects and medication interactions, you should check the recommended dose with your doctor before using aspirin for headaches or migraines.

You should not take aspirin in combination with other NSAIDs unless your doctor specifically tells you to.

Aspirin is also a common component of several over-the-counter and prescription medications, so keep that in mind as well.

Excedrin (acetaminophen, aspirin, caffeine)

There are four formulations of Excedrin, which contain a combination of acetaminophen, aspirin, and caffeine. Caffeine induces vasoconstriction (narrowing of the blood vessels), and migraines are associated with vasodilation (widening of the blood vessels) in the brain.

Excedrin Migraine and Excedrin Extra Strength both contain 250 mg of acetaminophen, 250 mg of aspirin, and 65 mg of caffeine per tablet. Excedrin Tension Headache formula contains 500 mg of acetaminophen and 65 mg of caffeine. Excedrin PM Headache contains 250 mg of acetaminophen, 250 mg of aspirin, and 38 mg of diphenhydramine citrate, an antihistamine that makes you sleepy. The dosage for each formulation varies, so it's important to read each label closely and take as directed.

Excedrin is a very effective headache and migraine medication, but any of the components can cause side effects. Common side effects include stomach upset, nervousness, and dizziness.

A Word From Verywell

Over-the-counter medications can be a valuable tool in managing your migraines or headaches. Remember, what works well for someone else may not work as well for you, so you may need to try a few to decide which one works best for you.

Also, taking too much over-the-counter medications for your headaches and migraines can trigger medication overuse headaches. If you are taking any of these medications more than two or three times per week, you should discuss your symptom frequency with your doctor (and whether or not another treatment may be advised) and consider employing migraine prevention strategies.

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