Medically reviewed by Dr. Charisse Litchman, MD, FAHS on January 26, 2021
Many headache sufferers reach for over-the-counter ibuprofen (like Advil or Motrin) or acetaminophen (aka Tylenol) or Excedrin Migraine when they develop a headache. Sometimes that will be enough to reduce or eliminate the headache pain, but often it either doesn’t work or only helps temporarily. After a few hours, the headache will return, and to be able to function at home and at work, headache sufferers will reach for additional doses throughout the day. For people with frequent or chronic headaches this can add up to a whole lot of over-the-counter painkillers.
Because over-the-counter medications don’t require a prescription they may seem harmless, but in fact taking these pills too frequently can cause real health problems. The first problem with taking ibuprofen (Advil or Motrin) is that these medications can erode the lining of your stomach and cause internal bleeding, and over time they can cause liver and kidney damage as well and pose potential cardiovascular risks. Acetaminophen (Tylenol) can cause liver damage, both over time and quickly (especially if combined with alcohol). A new OTC painkiller, Advil Dual-Action, contains both ibuprofen and acetaminophen, which may make it more effective for occasional use but also means more negative side effects if taken too often.
In the case of Excedrin Migraine you are taking not only acetaminophen but also aspirin (which can cause stomach bleeding in a similar way to Advil) and caffeine. Both caffeine and over-the-counter painkillers taken in excess cause Medication Overuse Headaches. Medication Overuse Headaches will eventually transform Episodic migraines (defined as 14 or fewer headaches per month) to Chronic migraines (15 or more headaches per month). Medication Overuse headaches are among the most difficult headaches to treat.
If you experience migraine headaches more than occasionally, you are better off treating them with a prescription medication, which will treat them more effectively and pose fewer risks than frequent use of OTC medications. By using medications developed specifically to treat migraines (triptans like Imitrex and gepants like Nurtec), the headaches will usually go away and stay away, and there are fewer potential side effects from triptans and gepants than from Excedrin and Advil. While triptans can cause Medication Overuse headaches if taken too often, they are needed less often because the headaches respond better to triptans than the over the counter medications. And, gepants do not have any potential to cause Medication Overuse Headaches.
The bottom line? Even if you think you can manage your headaches with over-the-counter painkillers, you’ll likely be better off both in terms of headache relief and overall health by consulting with a healthcare provider to get prescription medication.