Last updated: April 2023
“If she can take Excedrin and go back to work, then it’s not really a migraine.”
I bet you’ve heard this one a lot. Maybe you’ve even said it. I understand the sentiment. We have all been told “just take a pill” by someone who really doesn’t understand the nature of migraine. Many times the solution is a lot more complicated. It can be all too easy to begin thinking that pills don’t work for a “real” migraine.
Migraine ranges from mild to severe
Some people with migraine can and do get relief from OTC medicines like Excedrin, Aleve, Advil, or just aspirin. Migraine is a spectrum disorder. Some people experience only a few mild attacks each year. They may be acutely aware of their prodrome symptoms and able to abort the attack long before the pain is severe.
Over the counter treatment works for my mild attacks
While not true for everyone, some over-the-counter medicines can help stop a migraine attack. If you’re not ready to try prescription medications, you might consider talking to your doctor about using an over-the-counter medicine instead.
In my experience, these products have worked best for mild, infrequent attacks. The more frequent and severe the migraine attacks, the less likely it is for non-prescription treatment success.
NSAIDs and acetaminophen
NSAID is short for non-steroidal anti-inflammatory drugs. Non-prescription medicines in this drug class include aspirin, Aleve (naproxen), and Advil or Motrin (ibuprofen). There are a number of over-the-counter remedies that contain these drugs. Sometimes they are found in combination with Tylenol (acetaminophen) or caffeine. While there is no research supporting the use of acetaminophen to abort a migraine attack, there is ample evidence that caffeine, when taken in combination with an NSAID, can benefit some patients. Availability varies widely
Antihistamines and anti-emetics
These two are also available over-the-counter. The most commonly used antihistamine is Benadryl (diphenhydramine). It has been shown to improve the efficacy of both NSAIDs and triptans when taken together in the early minutes of the acute headache phase of a migraine attack. Dramamine (dimenhydramate) or Bonine (meclizine hydrochloride) can also help reduce the symptoms of nausea and vomiting. I have listed these two classes of drugs together because many anti-emetics (like Dramamine and Bonine) are actually antihistamines. They work best when taken either before or as soon as symptoms appear.
OTC medications and prescription triptans
On occasion, doctors will recommend combining an NSAID and/or antihistamine with a prescribed triptan. There is even a version of sumatriptan (Treximet) that is a combination of Imitrex and naproxen. For years, my rescue treatment plan has called for a combination of prescription-strength NSAID injections plus an antihistamine and an antiemetic. Whether administered in the ER or taken at home, I have been fortunate to enjoy consistently positive results from such cocktails when triptans fail.
Risks and warnings
Just because a medicine is available without a prescription doesn’t mean we should try to self-prescribe or self-treat. Many doctors are willing to discuss these options with patients. Because each person’s medical needs are unique, it is critical that we all keep an open line of communication with our doctors about all the medicines we are using.
- The FDA recently issued a warning that regular use of non-aspirin NSAIDs may increase the risk of heart attack and stroke. They have also been linked to stomach irritation, bleeding of the stomach lining, hearing loss, and medication overuse headache.
- Both antihistamines and antiemetics can cause drowsiness. Do not drive or operate machinery while taking these classes of medication.
As with all acute migraine treatments, over-the-counter remedies should be limited to 2-3 times per week to avoid the risk of medication overuse headache. If you find that you need to treat your symptoms more often, please talk to your doctor about preventive options.
Have others downplayed your migraine pain?