Over-the-Counter Medications for Migraine and Headache Relief

Headaches, including migraines, are common. It is estimated that one out of every six Americans experiences migraines or severe headaches. Over-the-counter (OTC) medications for migraines are typically tried first as they are readily available, generally work well, are cost-effective, and tend to have fewer side effects than prescription options.

Examples of common OTC medications for migraines include

• Aspirin (e.g., Bayer)
• Ibuprofen (e.g., Advil and Motrin)
• Naproxen (e.g., Aleve),
• Acetaminophen (e.g., Tylenol)

Follow any dosing instructions on the label and check in with your healthcare provider before beginning any new medications, especially if you have any health conditions or take other medications.

Non-Steroidal Anti-Inflammatories (NSAIDs)

Non-steroidal anti-inflammatory medications (NSAIDs) reduce inflammation and pain. While both NSAIDs and acetaminophen are considered first-line treatment for migraines, if a patient can tolerate NSAIDs, they are recommended over acetaminophen due to their greater effectiveness at reducing migraine-related pain.

All NSAIDs 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. Consult your provider before taking this medication if you have kidney or heart disease or a history of stomach bleeding. 

Different NSAIDs have various dosing. Be sure to follow the dosing instructions on the label.

Common OTC NSAIDs for migraines include:

Ibuprofen: More commonly known as Motrin or Advil, it tends to be better tolerated than other NSAIDs. It works quickly to relieve pain but stays in the body for less time than other NSAIDs, so more than one dose may be needed if the migraine lasts longer.

Naproxen: More commonly known as Aleve, it takes longer to begin working in the body than ibuprofen. However, it has a longer half-life, so it stays in the body longer.

Aspirin: One of the most commonly used NSAIDs, and often recognized under the brand name Bayer, aspirin is an anti-inflammatory, a blood thinner, and a pain reliever.

However, aspirin is more likely to cause bleeding than other NSAIDs, and it can cause additional side effects, such as a rash or ringing in the ears. Aspirin may also cause a severe allergic reaction, which manifests as facial swelling and breathing difficulties.

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

Acetaminophen

Acetaminophen, also known as Tylenol, is a common treatment for headaches and is considered a first-line treatment.

Acetaminophen is a well-tolerated medication, making it a good alternative if you can't take NSAIDs.

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. Acetaminophen products should never be mixed with alcohol.

If you have liver disease, check with your practitioner or healthcare professional before taking acetaminophen. Additionally, if you take acetaminophen several times a week for pain, such as headache-related pain, check in with your healthcare provider.

Tylenol, the maker of one of the most commonly recognized brand names for acetaminophen, recommends that adult consumers take no more than 3,000 mg of acetaminophen daily. For the maximum strength option, it recommends up to 1,000 mg (2, 500 mg tablets) every six hours for pain relief.

If this does not adequately control pain, then up to 4,000 mg may be taken at the discretion of a healthcare professional. Maximum daily dosing may vary based on an individual's health status and other medications they take.

Combination OTC Medications

In addition to OTC medications containing only one active ingredient, such as ibuprofen or acetaminophen, combination OTC medications exist. A common combination medication is Excedrin and its generic counterparts.

There are several formulations of combination OTC medications for migraines. The combinations vary depending on whether they are daytime or nighttime formulations. Each formulation contains a combination of acetaminophen, aspirin, and caffeine or diphenhydramine citrate.

Caffeine induces vasoconstriction (narrowing of the blood vessels). Since migraines are associated with vasodilation (widening of the blood vessels) in the brain, it is thought that adding caffeine can help.

However, caffeine can also keep you awake. So, to help you sleep, nighttime formulations skip the caffeine and include diphenhydramine citrate instead. This is an antihistamine that can make you sleepy. Sleep itself can often alleviate a migraine attack. Taking a combination medication that also promotes sleep may help relieve you of your migraine pain.

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.

Safety

It is essential to know which medications you take, what type of medication they are, and their active ingredients. As mentioned, too much acetaminophen, which is commonly found in combination products, can cause liver damage.

Avoid accidental overdoses: If you took 1,000 mg of acetaminophen for a headache and then it didn't go away, you should avoid combining OTC medications containing acetaminophen. However, your healthcare provider may be ok with you taking caffeine pills or drinking a soda containing caffeine and taking a dose of an NSAID, such as ibuprofen (e.g., Motrin), naproxen (e.g., Aleve), or aspirin.

You also shouldn't take several NSAIDs together as this could increase the risk of ulcers or gastrointestinal bleeding. A large overdose could cause kidney damage, seizures, and coma. Be aware that while ibuprofen, naproxen, and aspirin are all different medications, they are all considered NSAIDs and should not be combined unless under the recommendation of a healthcare professional.

Medication overuse headaches: Using OTC medications too frequently for headaches can also cause a condition known as a medication overuse headache (MOH). If you find yourself using OTC medications several times a week to treat headaches, contact your healthcare provider for advice.

Your healthcare provider can help you safely wean off of the medications you have been taking and explore alternative treatment options with you. For example, if you are experiencing daily migraines or migraines several times a week, they may prescribe a more effective medication or a daily preventative.

Avoid aspirin in kids and teens: Unless recommended by your healthcare provider, do not give aspirin or aspirin-containing products to children or teenagers. This is due to an association between aspirin and a rare, life-threatening condition called Reye's syndrome in kids and teens.

Reye's syndrome is a serious condition that affects the brain and liver. It tends to occur with viral infections in kids, and aspirin is associated with an increased risk of the condition.

Pregnancy: The American College of Obstetricians and Gynecologists (ACOG) recommends acetaminophen (Tylenol) as a first-line OTC medication for migraines and headaches during pregnancy. If acetaminophen doesn't work, your healthcare provider may recommend NSAIDs—but only during the second trimester and only for a short duration.

Speak with your healthcare provider before taking any medications while pregnant.

Alternative OTC Treatments

Other alternative OTC options for migraine treatment include the use of special migraine headbands, aromatherapy, and CBD-containing products.

To prevent migraines, many individuals take supplements. Managing stress through therapy options, such as cognitive behavioral therapy (CBT), is also helpful. Acupuncture may also be beneficial in migraine prevention.

Migraine headbands: These headbands work by applying pressure at various points on the head. Several different options are available. Some cover the eyes, some are cooling, and one option, the Cefaly headband, works by sending an electrical signal to the trigeminal nerve. Cefaly is FDA-approved and available without a prescription.

Aromatherapy: Some individuals believe various essential oils, such as lavender and peppermint oil, can relieve migraines. However, a systematic review and meta-analysis (a type of research article that examines several research studies on a topic) found that aromatherapy treatments were no more effective than placebo for migraine pain.

However, some of the studies reviewed did support the findings that aromatherapy may help reduce other uncomfortable migraine symptoms such as phonophobia (aversion to loud sounds or perceived loud sounds), nausea, and vomiting.

CBD and medical marijuana: CBD-containing products and medical marijuana may be effective migraine treatments. However, additional high-quality studies are necessary to study these products and their effect on migraines.

Supplements: OTC supplements such as coenzyme Q10, riboflavin (vitamin B2), feverfew, and magnesium have been studied for their effectiveness in migraine prevention and treatment. These supplements may reduce the frequency and severity of migraines.

If you are interested in adding OTC supplements to your medication regimen, discuss it with your healthcare provider to ensure they are safe for you and will not interact with medications you are already taking.

Cognitive behavioral therapy (CBT): CBT is one therapy option that can help reduce stress. Stress is often identified as the most common trigger for migraines. CBT is an effective stress management tool. While it is typically done with a licensed mental health therapist, there are also workbooks and apps you can try depending on your situation.

Acupuncture: Acupuncture may be an effective treatment to reduce how often you experience migraines. While you can seek acupuncture treatment on your own, your insurance may cover acupuncture for certain conditions, such as headaches, with a prescription from your provider. Reach out to your insurance carrier for additional information and coverage.

Prescription Medications

Sometimes, OTC medications and treatments aren't enough to treat and manage migraines. There are two main types of prescription migraine treatment:

• Medications that treat migraines as they occur: Providers can prescribe several medications to stop migraines. Triptans are one of the most common and most effective medications prescribed. While some triptans are available OTC in several countries, they require a prescription in the United States.
• Preventative medications: If you experience four or more headaches a month or eight or more headache days a month (sometimes a headache episode lasts more than a day), your healthcare provider may recommend a daily medication to prevent headaches. Several first-line medications are available, and if these aren't effective, additional second-line therapy options are available.
  

Summary

OTC medications for migraines are often effective. The main OTC medications for migraines include acetaminophen, NSAIDs, and combination medications. Other OTC treatments are available. Additional prescription pain relief medications can provide further pain relief.

What works best and fastest for you may not be the best option for someone else. Additionally, recommended and maximum doses of medications an individual can take at a time will vary based on their other underlying health conditions and medications.

It's also essential to consider that taking OTC medication for your headaches and migraines too frequently can trigger medication overuse headaches. If you are taking OTC pain medications more than two or three times per week, discuss your symptom frequency with your healthcare provider and whether or not another treatment may be advised.