Is Tylenol or Advil Better for Treating a Headache?

Pharmacist advising man on the benefits of a drug

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If you endure occasional tension headaches, you may wonder what pill bottle to reach for in your desk drawer or medicine cabinet at the onset of an attack.

In other words, should you reach for the Tylenol (acetaminophen) bottle or the Advil or Motrin (ibuprofen) bottle? Is one more effective than the other?

Let's investigate this question further.

Treatment of Tension-Type Headaches

Typically, people with tension headache self-treat with over-the-counter medications and other non-medical therapies like sleep, exercise, water, and caffeine. People tend to go to a doctor's clinic only when their headache is resistant to these therapies, or when they experience other symptoms in addition to their headache, such as visual changes from an aura (this actually suggests a diagnosis of a migraine and not a tension headache).

Classic examples of over-the-counter medications for tension-type headaches are:

  • Tylenol (acetaminophen)
  • Nonsteroidal anti-inflammatories, or NSAIDs like Aleve (Naproxen Sodium), Motrin/Advil (Ibuprofen)

What Research Says About Ibuprofen Versus Tylenol

So which bottle do you grab from your medicine cabinet or desk drawer? Well, either would most likely work, although ibuprofen may be more effective.

In an older study, in the Journal of Clinical Pharmacology, over 450 individuals with tension headache were randomized to receive either 400 mg ibuprofen, 1000 mg of Tylenol, or placebo. Results showed that both ibuprofen and Tylenol were more effective than placebo in alleviating headache, and ibuprofen was found to be more effective than acetaminophen.

That being said, other studies have found no difference between Tylenol and NSAIDs in alleviating tension headache pain.

For example, a review study in Pain found both Tylenol (1000 mg dose) and ibuprofen (400 mg dose) to be better than placebo at easing moderately to severely painful tension headaches (using the parameter of being pain-free two hours after taking the medication). Neither was found to be more effective than the other.

The study also found that the number of people needing to take either Tylenol or ibuprofen to obtain headache relief at two hours was nearly nine for both. This is rather high and means that there is still a lot of people who are not getting proper relief—a bit of an unsettling feeling.

Consider Potential Adverse Effects

In addition to medication effectiveness, it's critical to consider the potential adverse effects of each medication.

Acetaminophen, while generally well-tolerated, may cause liver failure in high doses.

As a nonsteroidal anti-inflammatory (NSAID), Advil (ibuprofen) should be avoided by some people, as it may cause peptic ulcer disease and bleeding, kidney failure, and worsening of underlying high blood pressure. Moreover, NSAIDs increase a person's risk of adverse cardiovascular effects, like a heart attack or stroke.

In general, NSAIDs should be avoided by people with certain health conditions, like those with a history of stomach bleeding, kidney disease, and/or heart disease. People with a history of asthma should also be cautious about taking NSAIDs, as they may trigger airway inflammation.

Furthermore, in pregnancy, acetaminophen is generally the preferred choice for a tension headache, although be sure to confirm with your obstetrician.

Ibuprofen Versus Tylenol

The answer is that either Tylenol or an NSAID is a reasonable first-choice option for alleviating your tension headache. In terms of dosage, a 200 or 400 mg dose of ibuprofen is a typical dose. If you take naproxen sodium (Aleve), a typical single dose is 220 or 550 mg.

Of course, it's important to always speak with your healthcare provider before taking any medication, including those that are over-the-counter, to make sure it is safe for you.

If you have frequent or chronic tension headaches, it's not good to regularly take analgesics for pain control. This can actually backfire and cause a medication-overuse headache, which can be difficult to distinguish from your regular tension headaches—a double whammy, so to speak.

When Tylenol or Ibuprofen Fails

If you don't obtain headache relief from a dose of Tylenol or an NSAID, a next practical choice would be to consider a two-tablet dose of caffeine combined with a pain reliever, like Excedrin Extra Strength (which contains acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg).

In fact, for some people, starting off with a combination of analgesic and caffeine may even be better for easing an episodic tension-type headache than a simple analgesic (like Tylenol or ibuprofen). That said, you may experience more side effects, like stomach upset or dizziness (although, these are generally mild and short-lived).

You also have to consider the fact that a combination analgesic like Excedrin contains both aspirin (an NSAID) and acetaminophen.

A Word From Verywell

In the end, if you have episodic tension headaches and want to take an over-the-counter medication, either ibuprofen or Tylenol is a sensible choice. You may get more benefit from ibuprofen, but this is not a hard and fast rule. As always, speak with your doctor before you take any medication.

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Additional Reading
  • Diener HC. Headache: insight, understanding, treatment and patient management. 404Int J Clin Pract Suppl. 2013 Jan;(178):33-6. doi: 10.1111/ijcp.12049.

  • Taylor FR. (2017). Tension-type headache in adults: Acute treatment. Swanson JW, ed. UpToDate. Waltham, MA: UpToDate Inc.