Tylenol or Advil for Headache

How to Choose the Most Effective Pain Reliever

Tylenol (acetaminophen) and Advil (ibuprofen) can both treat headaches but work differently. While Tylenol and Advil both have analgesic (pain-reducing) and antipyretic (fever-reducing) effects, Advil also has anti-inflammatory effects that can reduce swelling and pain throughout the body.

Choosing the right painkiller may depend on whether a headache occurs on its own or is accompanied by other symptoms. Other factors like drug side effects or pre-existing medical conditions (such as stomach ulcers or liver disease) may need to be considered to ensure you get the safest and most effective option.

This article reviews how Tylenol and Advil work to treat headache pain. It also describes the possible risks and how to safely use these popular, over-the-counter (OTC) painkillers.

Pharmacist advising man on the benefits of a drug
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Choosing Tylenol or Advil for Headaches

Tylenol is classified as an analgesic and antipyretic drug mainly used to treat fever and help ease mild to moderate pain. It does so by blocking an enzyme called cyclooxygenase (COX) that helps create inflammatory compounds, called prostaglandins, that contribute to headache pain.

Advil (also sold under the brand name Motrin) is classified as a nonsteroidal anti-inflammatory drug (NSAID) that also blocks COX but has wide-ranging effects. While Tylenol only works on the brain, Advil and other NSAIDs work on the brain and the rest of the body.

This doesn't necessarily mean that Tylenol is the lesser option for treating headaches. While some studies suggest that Advil may be better at treating acute headache pain, Tylenol typically causes fewer side effects and is considered the safer option for long-term (or postoperative) use.

On the other hand, Tylenol may not be "strong" enough if headache pain is associated with inflammatory conditions like arthritis. Tylenol may also be better when fever is involved, lowering temperatures more and longer than Advil.

In the end, the choice is based largely on the individual case, weighing the benefits against the risks.

Advil vs. Aleve

Aleve (naproxen) is another NSAID that can be for headaches. It is considered equally effective as Advil but works longer. While Advil needs to be taken every four to six hours, Aleve can be taken every eight to 12 hours.

Risks of Taking Tylenol or Advil

While Tylenol and Advil can often be equally effective in treating a headache, they come with certain risks and side effects.

Risks of Tylenol for Headaches

If taken in high doses, Tylenol can cause liver injury and damage. This is especially true if you drink heavily while taking the drug. Although drinking a small amount of alcohol will usually not cause liver injury, people with chronic alcoholism may experience severe hepatotoxicity (liver poisoning) by drinking alcohol with a single, high dose of Tylenol.

Due to its effects on the liver, Tylenol should be avoided in people with severe liver disease or an acute liver infection like viral hepatitis.

Adults should not take more than 3,000 milligrams (mg) of acetaminophen per day. You should take even less if you are 65 years or older. 

Check the label of any medications you take as products like cold & flu medicines contain acetaminophen. If you're not careful, you can easily go over the maximum daily limit without knowing it.

Acetaminophen is generally a safe choice for treating headaches if you're pregnant but check with your healthcare provider just to be safe.

Risks of NSAIDs for Headaches

NSAIDs are well known to affect blood clotting if overused. This can lead to gastrointestinal symptoms as well as the formation of stomach ulcers.

By suppressing the production of prostaglandins, which help increase blood flow to the kidneys, NSAIDs might also reduce kidney function. This, in turn, can increase blood pressure and contribute to heart disease.

Because of this, some people need to avoid NSAIDs if they have health conditions like:

If you have risk factors for stroke or coronary artery disease, NSAIDs may increase your risk of having a heart attack or stroke.

You should also avoid NSAIDs before and just after surgery to reduce the risk of postoperative bleeding. (This is why Tylenol is typically given after surgery instead of an NSAID.)

During pregnancy, Advil is not recommended for use after week 20 of gestation. Some studies have suggested reports that the prolonged use of NSAIDs during pregnancy may affect the kidneys, heart, and lungs of the developing baby.

Can OTC Painkillers Cause Headaches?

If you get frequent or chronic headaches, regularly using OTC pain relievers can actually cause a medication-overuse headache, also called rebound headaches.

If you get caught in this cycle, you may not be able to tell your usual tension headache from a headache that's being caused by the medication you're using to treat it.

How to Tylenol and NSAIDs Safely

Tylenol and NSAIDs like Advil and Aleve can be used to treat headaches. Choosing the one that is right for you will depend on your needs, preferences, and risk factors.

The recommended dosage for adults and children over 12 years are:

  • Tylenol: 325 mg taken every four to six hours or 650 mg taken every eight hours
  • Advil: 200 to 400 mg taken every four to six hours
  • Aleve: 220 to 440 mg taken every eight to 12 hours

Tylenol can be taken on an empty stomach. On the other hand, NSAIDs can irritate the stomach lining, so it is best to take them with food or a glass of milk.

Before using any OTC painkiller for a headache, speak with your healthcare provider and tell them about any drugs or supplements you take. This can help reduce your risk of side effects, complications, and drug interactions.

Can You Take Tylenol and Advil Together?

Because these pain relievers work differently, it's usually safe to take Tylenol and Advil together. Many healthcare providers will advise you to separate the doses by at least a few hours to help avoid side effects like stomach upset.

On the other hand, you should never take two NSAIDs, like Advil and Aleve, at the same time as it may double the risk of side effects.

What to Do if Tylenol or Advil Does Not Help a Headache

If taking Tylenol or an NSAID does not relieve your headache pain, there are other OTC options. For example, you can a two-tablet dose of Excedrin Extra Strength which contains a combination of:

  • Acetaminophen (250 mg)
  • Aspirin (250 mg)
  • Caffeine (65 mg)

Keep in mind that pain relievers with combined ingredients like Excedrin may cause side effects, such as stomach upset or dizziness. That said, these side effects are usually not serious and do not last very long.

Also, remember that Excedrin contains both aspirin (an NSAID) and acetaminophen. Be sure to stay within the recommended daily dosage limits for each medication, especially if you are taking more than one.

You should not take any OTC painkiller for an unlimited period of time. To prevent side effects, take the lowest dosage needed for the shortest amount of time.

When to Talk With a Healthcare Provider

Talk to your provider if you've been having headaches with other unusual symptoms as this could be a sign of something serious.

For example, vision changes like an aura could mean that you're having a migraine rather than a regular headache. Or, a headache with a stiff neck and extreme light sensitivity might suggest a potentially life-threatening case of meningitis.

If you've been taking an OTC painkiller for more than 10 days and still have pain, talk to your healthcare provider as soon as possible.

How to Treat Headache at Home

Tension headaches are the most common kind of headache. Unlike other headache types, tension headaches are not caused by a medical condition but by triggers such as:

Tension headaches can benefit from the occasional use of OTC painkillers but can sometimes be better managed over the long term by:

  • Going to sleep and waking at the same time each day
  • Eating regular meals without skipping any, especially breakfast
  • Exercising regularly
  • Drinking more water
  • Resting in a quiet, dark environment when needed
  • Practicing stress management (such as yoga, meditation, or deep breathing exercises)

Summary

Advil and Tylenol are common OTC medications for headache relief. Research supports the use of either for most tension-type headaches.

However, Tylenol can be hard on the liver if taken too long or in high doses. If you have liver disease or drink heavily, you should avoid Tylenol.

NSAIDs like Advil carry a risk of peptic ulcers, kidney failure, and high blood pressure. Thus, if you have a history of stomach bleeding, kidney disease, or heart disease, you should not take NSAIDs.

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Additional Reading
Colleen Doherty, MD

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.