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What's The Best Over the Counter Migraine Medicine?

For people who are familiar with the crushing pain of a migraine, the first signs of an attack are enough to shut down their normal daily activity. Migraines are the second most common type of reported headaches, and an approximated 50 million Americans suffer from them according to the American Migraine Foundation. Migraine is different from a regular headache in that it is caused by electrical activity in the brain. The characteristic symptoms of a migraine headache include: 

  • Light sensitivity
  • Sensitivity to loud sounds 
  • Nausea
  • Vomiting
  • Intense throbbing or pulsing on one or both sides of the head

People who suffer from migraines generally try to avoid triggers that can cause an onset of symptoms, but this is not always possible. Common triggers include bright lights, loud sounds, strong scents, alcohol, certain foods that contain monosodium glutamate or tyramines, weather conditions or hormonal changes in women. There are many medications on the market to help treat migraine symptoms, and some medications prevent their occurrence as well. Migraine is considered to be a disease, and if you experience more than four migraine headaches per month, you may suffer from chronic migraine. The treatment method for chronic migraine is largely with prescription drugs that aim to prevent the occurrence of migraine in the first place. 

Over the counter (OTC) medications mostly help treat symptoms of a migraine headache. Most OTC medications used to treat migraine headaches are general painkillers that you are probably already familiar with and have taken at some point for other conditions.  These include the non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve), and acetaminophen (Tylenol), which is commonly used to reduce fever.  A few OTC medications like Excedrin Migraine and Advil Migraine are specially formulated to treat migraine headaches. With many choices of OTC painkillers to treat migraine headaches, how do you know which one to choose? 

The different OTC drug options are described here to help you select the right migraine medication for you. 

Ibuprofen 

Ibuprofen is one of the major NSAIDs. Advil and Motrin are the most well known brands of ibuprofen. NSAIDs can reduce pain by reducing inflammation in the body. The way that NSAIDs work is by inhibiting the production of prostaglandins that play a major role in how we feel pain. NSAIDs block the action of a protein called COX that is important for the production of prostaglandins. By reducing prostaglandin levels, we feel less pain. 

Each tablet of Advil contains 200 mg of ibuprofen. The recommended dosage for adults is two tablets every four to six hours with a full glass of water. For children, the recommended dosage is based on the weight of the child. It is best to consult a doctor before children take Advil. Advil Migraine is a formulation of ibuprofen that is in liqui-gel caps. This makes the absorption of the medication faster to achieve quicker pain relief. According to the manufacturer of Advil Migraine, the medication takes about one hour to work and start providing relief. Both medications are readily available in all major drugstores, pharmacies and supermarket chains. 

NSAIDs like ibuprofen have some side effects associated with it, such as increasing the risk of stomach bleeding or stomach ulcers. Both Advil and Advil Migraine come with the risk of these side effects. So if you have a history of peptic ulcers or inflammatory bowel disease, taking ibuprofen to treat your migraine may not be the best option for you. NSAIDs can also increase the risk of a heart attack or stroke. 

Naproxen 

Naproxen also belongs to the NSAID class of drugs. Naproxen is available as naproxen sodium as well, which is more readily absorbed into the blood. Higher strengths require a prescription, but lower strengths are available as OTC drugs known by the name of Aleve. Naproxen works in a similar way to ibuprofen in reducing prostaglandin production to relieve pain. 

Naproxen is available as tablets, caplets or liquid form, and the dosage is recommended according to the use of the medication. The recommended dosage to treat migraine headaches is 550 mg of naproxen sodium every 12 hours. If this doesn't work, the dosage can be increased but should not be more than 1,375 mg per day. Naproxen sodium remains active in the body longer compared to other NSAIDs. Side effects include stomach upset or stomach bleeding, nausea, vomiting, rash, liver damage and increased risk of stroke or heart attack. 

Naproxen starts working in the treatment of migraine headaches about 2 hours after taking the medication. But, for many people, naproxen sodium does not work as well as other NSAIDs in relieving migraine headache pain. A Cochrane Systematic review from 2013 that examined data from six clinical trials containing 2,700 people who took naproxen or placebo for migraine headaches found that the drug is effective in reducing migraine pain in adults, but its effect was relatively weak. The study concludes that other NSAIDs may work better for treating migraine headache pain. 

Acetaminophen

Acetaminophen, known by the popular brand name Tylenol, does not belong to the NSAIDs and works in a different way to reduce pain. Like the NSAIDs, acetaminophen also reduces the amount of prostaglandins, but is thought to do this through altering chemical substances that affect the central nervous system. In this way, acetaminophen makes the intensity of pain feel less. 

When taken alone, acetaminophen is not as effective as ibuprofen in relieving the pain of a migraine headache, but it does not have the side effects of stomach bleeding or stomach ulcers like NSAIDs. So, it is a good choice to relieve pain for people who cannot take NSAIDs. The recommended adult dosage of Tylenol is two pills every six hours, for regular or extra-strength, and no more than 3,000 mg should be taken daily.  

Tylenol Ultra Relief contains 500 mg of acetaminophen and 65 mg of caffeine. The recommended dosage for adults is one tablet every four to six hours or two tablets in the next dose if one tablet alone is ineffective. No more than eight tablets should be taken within 24 hours. Clinical studies have shown that acetaminophen works better to treat migraines when it is in combination with caffeine, so this also an option for you if you cannot take NSAIDs. 

Acetaminophen can cause an increased risk of liver damage if more than the recommended dose is taken. If you drink more than three alcoholic beverages a day, taking acetaminophen can also increase the risk of liver damage. Caffeine in Tylenol Ultra can cause trouble sleeping. 

Excedrin Migraine

What’s in Excedrin Migraine? Excedrin Migraine is a combination medication that contains three active ingredients: 250 mg of aspirin, 250 mg of acetaminophen and 65 mg of caffeine. Each active ingredient works to reduce the pain associated with a migraine headache. Aspirin belongs to the NSAIDs, and works by reducing prostaglandin levels that cause pain just like ibuprofen or naproxen. Caffeine may seem like a surprising component, but it is thought to help relieve pain by constricting blood vessels that are normally widened during a migraine attack and cause the feeling of pressure in the head. 

The recommended dosage for adults above the age of 18 is two tablets within a 24-hour window. The medication takes 30 minutes to one hour to work, with many patients reporting pain relief in as little as 30 minutes. Since Excedrin Migraine contains three active ingredients, the side effects you may experience when taking this drug are due to all three ingredients. They include stomach bleeding or stomach ulcers, increased risk for liver damage, rash, and the caffeine component can cause inability to sleep or to stay asleep. 

Like acetaminophen, aspirin works better to treat migraine headache pain when it is taken as a combination rather than alone. The combination ingredients found in Excedrin Migraine make it extremely effective as an OTC medication to treat migraine pain. If you are able to tolerate the potential side effects of aspirin and acetaminophen, this medication could be a good choice for you. 

The bottom line 

The medication that you choose to treat migraine headaches should depend on how severe your migraine is and how frequently they occur. You should also consider your medical history including pre-existing conditions that may make you tolerate one medication better than the other. Drug interactions are another factor that could help you decide which medication to choose. Each OTC medication described here can potentially interact with certain other medications, so be sure to check with your doctor or pharmacist before taking a new medication. 

If you can tolerate NSAIDs, medications that contain this active ingredient are your best bet at relieving migraine headache pain. Both Advil or Advil Migraine and Excedrin Migraine contain NSAIDs. Which one is better? Advil Migraine takes about one hour to start working, whereas Excedrin Migraine can start working in about 30 minutes. Additionally, clinical studies have shown that the combination of active ingredients in Excedrin Migraine are significantly more effective and work faster than ibuprofen in treating acute migraine. 

It is best not to combine OTC drugs for the treatment of migraine. If you take OTC drugs and do not get enough relief from them, or if the number of times you suffer from migraine headaches in a month increases, consult your doctor to find out whether prescription drugs may be right for you to treat or prevent them from occurring. 

Published September 2nd, 2020 by Chris Riley
Fact Checked by Chris Riley

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