Over-the-Counter Medications for Migraine or Tension Headaches

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 that 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 4000 mg, and prolonged use can cause liver or kidney damage and may be life-threatening. Acetaminophen should be use with caution if you have liver disease—be sure to check with your doctor or healthcare professional before taking.

Keep in mind that acetaminophen is present in some combination pain medications, like Excedrin, Percocet, and Vicodin. Be sure to consider the amount of acetaminophen that you are already taking 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, while in others they are equivalent. While it can be used at higher doses if you have an inflammatory condition, such as arthritis, the maximum daily dose when used for pain or headaches is 2400 mg.

Ibuprofen can cause stomach upset and may induce a tendency to 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, Naprosyn (naproxen) 

Naproxen, like ibuprofen, 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 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.

Naprosyn is approved for treatment of pain, including tension headaches, at a dose of 250 to 500 mg every 12 hours, not to exceed 1250 mg per day. For migraines, it is used off-label at an initial dose of 750 mg, followed once by 250 to 500 mg if needed, not to exceed 1250 mg per day.

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; and Excedrin PM Headache contains 250 mg of acetaminophen, 250 mg of aspirin, and 38 mg of diphenhydramine citrate, an antihistamine that makes you sleepy.

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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