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Over-the-Counter Headache Treatments

Treat Migraines the OTC Way


Updated June 11, 2014

While migraines are annoying and at times disabling, treatment choices don’t have to be confusing, especially when it comes to over-the-counter headache treatments. In general, there are two basic types of treatments for migraine headaches: abortive and preventative. Abortive treatments seek to stop a headache once it’s started. Preventative medications are taken frequently, often daily, in order to prevent migraines from starting in the first place. Among the abortive treatments, a number are available over the counter (OTC). As with all headache treatments, be sure to discuss your intentions and concerns with your healthcare practitioner.

Tylenol (Acetaminophen)

While the FDA has not officially approved Tylenol for the treatment of migraine headaches specifically, many people use this medication. A few studies support its use, however. It probably works through blocking the actions of prostaglandins, chemicals in the body that are involved in inflammation and pain. While Tylenol is relatively safe, overdose can be dangerous and even fatal. The maximum daily dose of Tylenol is 4000 mg (or 4 g), and given the range of acetaminophen products available, special care needs to be taken when using it. Also, acetaminophen is present in many combination pain medications (such as Percocet and Vicodin), so be sure to consider these medications as well when you are calculating your daily dose.


Aspirin has been around for a long time and has been a mainstay of headache treatment for years. It works by inhibiting inflammation, as do many of the basic treatments for migraine. Several studies show that aspirin can be effective in treating migraines, but these same studies often show that other treatments may be just as effective. Also, many of these studies were performed outside of the United States using dosages and products not available within the U.S. Aspirin can cause gastrointestinal bleeding and tinnitus when used at higher doses. While it may be helpful for some migraine sufferers, aspirin may not be the best OTC choice.

Caffeine-Containing Medications

A combination of caffeine, acetaminophen, and aspirin (Excedrin) is an effective treatment for migraine headaches. Caffeine is added to these other medications in order to increase their absorption in the stomach and their activity in the body. This treatment is at least as effective as non-steroidal anti-inflammatory medications, such as ibuprofen, and the triptan class of medications. The most common side effect is stomach upset, probably due to the aspirin component. Other side effects include nervousness and dizziness, likely caused by the caffeine.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are one of the most commonly used medications for all types of pain. They work similarly to aspirin, blocking the inflammatory activity of prostaglandins. Numerous forms are available, but nearly all the OTC products are ibuprofen. Naproxen (brand name Naprosyn) is popular as well, but most studies involving NSAIDs and migraine use OTC strengths of ibuprofen. Ibuprofen in appropriate OTC dosages is effective in treating mild to moderate migraines with the most common side effects involving the gastrointestinal tract. Stomach pain and nausea and vomiting can be quite common. Gastrointestinal bleeding would be the most likely serious side effect, and should be reported to your healthcare provider immediately. The maximum daily dose for ibuprofen is 800 mg taken every 3 hours. Many physicians recommend taking ibuprofen regularly for no more than two weeks in a row because of the risk of bleeding.


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Diener H-C, Kaube H, Limmroth V. A practical guide to the management and prevention of migraine. Drugs. 1998;56(5):8111-8124.

Goldstein J, Silberstein SD, Saper JR, Ryan RE Jr, Lipton RB. Acetaminophen, aspirin, and caffeine in combination versus ibuprofen for acute migraine: results from a multicenter, double-blind, randomized, parallel-group, single-dose, placebo-controlled study. Headache. 2006;6(3):444-453.

Goldstein J, Silberstein SD, Saper JR, et al. Acetaminophen, aspirin and caffeine versus sumatriptan succinate in the early treatment of migraine: results from the ASSET trial. Headache. 2005;45;973-982.

Kellstein DE, Lipton RB, Geetha R, et al. Evaluation of a novel solubilized formulation of ibuprofen in the treatment of migraine headache: a randomized, double-blind, placebo-controlled, dose-ranging study. Cephalalgia. 2000;20:233-243.

King DS, Herndon KC. Headache disorders. In: Dipiro JT, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 6th ed. New York, NY: McGraw-Hill; 2005:1105-1121.

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