Non-prescription abortives

“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.

Well guess what?

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.

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

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.

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.

OTC doesn’t mean there isn’t risk.

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. “Caution: Some Over-the-Counter Medicines May Affect Your Driving”, FDA, October 7, 2014, retrieved 11/30/2015 at http://www.fda.gov/forconsumers/consumerupdates/ucm417426.htm
  2. DeMaagd, George, PharmD, BCPS, “The Pharmacological Management Of Migraine, Part 1 Overview and Abortive Therapy”, Pharmacy Times, July 2008; 33(7): 404-416, retrieved 11/30/2015 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740949/
  3. “FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes”, FDA, July 9, 2015, retrieved 11/30/2015 at http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm

Comments

View Comments (17)
  • Angiestl
    3 years ago

    I take generic Excedrin way too often, I’m quite sure, but as far as I can tell I don’t get medication overuse headaches from it. I can go days without it, on the rare occasions I don’t have a headache of any kind. If I could get a handle on my prodome symptoms, I could probably get ahead of any migraines or headaches I might have. I suffer from a couple neurological disorders that can cause anything from a mild headache to a full out migraine or even a headache caused by high cerebral spinal fluid pressure on the brain. Literally the CSF is compressing the brain on all sides. The name of this condition is Intracranial Hypertension. There is no pain relief for one of these headaches, the only way to get relief is to lower the pressure, either by a lumbar puncture or medication such as a diuretic. (These are sometimes referred to as suicide headaches, since it’s so hard to get relief.) It was this condition that most likely caused my migraines, though I remember having “tension headaches” all the way back to 1985. Plus I’ve had a couple traumatic brain injuries.

    But regardless of all these diseases and injuries and problems revolving around my poor broken brain, Excedrin does work to at least take whatever kind of headache down to a manageable level, working even better when I remember to take Benadryl with it. All the rx abortives and rescue meds I’ve tried have not worked. A couple worked at the very beginning but now they are a waste of money, since they are so expensive. If I’ve waited too long to take the Excedrin, the only thing that has a chance of working is Fioricet, with no codeine. And again, it usually just takes the headache of whichever kind down to a tolerable level.

    I am the perfect example of one person having a bunch of different kinds and severities of headaches and migraines. The OTC meds don’t work for every headache or migraine, but it’s easier to start on the low end of the medication wheel and work my way up than to start at the top and hope to find something on the way down that works. Oh! By the way, I’m on two or three preventatives to go along with all the other stuff I take. And I have had a friend and my mother suggest that I just quit taking everything because I’m just taking too much stuff. I’m not sure I’d want to see how I felt if I stopped everything cold turkey as they suggested!!

  • huggi001
    3 years ago

    Just wanted to mention, whether OTC or prescription, to be careful about overuse. Especially with OTC, medication overuse headache (aka rebound headache), can creep up on you. Next thing you know you not only have the migraines to deal with, but a daily constant headache that won’t go away. Worse part is that you then have to go off all meds (triptans, OTC, etc), to get rid of the daily headache. I believe that current recommendations are to use no combination of analgesic, triptan or opioid no more than 2 times a week.

  • Tammy Rome author
    3 years ago

    Absolutely! There aren’t any abortives that don’t carry this risk. That’s why it’s so important to avoid triggers when we can and use preventives if needed to reduce the number of attacks.

  • Lisa Moore
    3 years ago

    I have been using frankincense oil as an abortive, and it works for me. Sometimes I will have to follow up with Maxalt, but my Maxalt use is way down after trying frankincense. I buy mine from Amazon and you touch the dropper to your thumb and hold your thumb to the roof of your mouth for a few seconds. It works for my 16 year old daughter as well.

  • Tammy Rome author
    3 years ago

    That’s an interesting one. I’ve used it for arthritis pain in my knee with mixed results. Never thought about trying it for migraine. Love learning something new!

  • Lisa_CM
    3 years ago

    OTC meds do nothing for me, and haven’t for many years. Tammy, I’m not trying to nitpick, but I think it’s important to clarify…NSAIDS, antihistamines, and antiemetics are rescue medications, not abortive medications. They don’t stop the migrainous process – they only make us more comfortable until the migraine runs its course. I had no idea about the difference until I read Teri Robert’s migraine.com article back in August 2013! 🙂

  • Tammy Rome author
    3 years ago

    You are absolutely correct that anithistamines and antiemetics alone are rescue treatments. I mention them in this article because when used in combination with NSAIDs and/or triptans, they can improve the overall effectiveness of those abortive treatments. However, NSAIDs are indeed abortives for some patients, especially those who cannot take triptans. Some require prescription-strength NSAIDs while others can get results with OTCs.

    Always a pleasure meeting another Teri fan! 🙂

    Source: http://www.americanheadachesociety.org/assets/1/7/Non_Steroidal_-_January_2013.pdf

  • Karen Curry
    3 years ago

    For me, OTC is like taking nothing, it doesn’t even put a dent in my migraines. I find it hard to believe that anyone with real migraines find relief with OTC meds. But, if they do then good for them. I just don’t want their OTC relief to put a bad light on the severity of how bad migraines can rally be.

  • Tammy Rome author
    3 years ago

    That’s the important thing for everyone to know. Migraine attacks can be mild, infrequent, and easily managed. They can also be horribly debilitating and ruin lives because they are so difficult to treat. No two migraineurs are alike. We should accept each other’s experience as valid even if it’s not just like ours. https://migraine.com/blog/real/

  • Casingda
    3 years ago

    Oh, and one other thing. OTC meds will no longer even put a dent in my migraine headaches. I might as well be taking a placebo.

  • Casingda
    3 years ago

    I’ve had migraines for almost 45 years. In that time, I’ve gone though a progression of meds. There was a time when aspirin would work for me. Then I went to Tylenol, upping the amount until I was up to four at a time, but that stopped working. Then to Ibuprofen. And even Tynelol with Codeine one time. I also used what are called 222s from Canada, which are OTC there and contain aspirin, caffeine and codeine. They’d work on and off. However, there came a time when taking four ibuprofen at a time finally stopped working. That’s when I actually saw a specialist so I could start getting prescription meds. Even then, I’d still use some of the non-prescription remedies, too. I even tried Excedrin migraine, but all it did was make me feel worse. The caffeine had a negative effect on me. So I know how this goes. Just as migraines change over time, so can the meds we use to treat them. I’ve even had to switch abortives over time, as first Imitrex and then Zomig stopped working for me. It’s been several years now that I’ve been taking Maxalt, and it’s continued to work for me.

  • Calico Ghost
    3 years ago

    That used to be me. I would get migraines a few times a month. Excedrin works for me if I take it at the beginning of the pain (no aura.) Then I got ulcerative colitis and was told not to take anything containing aspirin. And my migraines now happen several times a week. Imitrex works ok, if I take it soon enough, but it takes hours to kick in. (When it doesn’t work I still cheat and take Excedrin.) I also can’t take ibuprofen because it once caused a burst vein in my leg.

    Thanks for the tip about Benadryl, I will have to try that one. Still trying to find an effective preventative. Thing about migraines that I am learning – you can start on the low end of the spectrum but there are no guarantees that you’ll stay there!

  • David
    3 years ago

    When I first discovered I had migraines, I tried Imitrex. I found it left me drowsy and nearly non-functional for two days after one dose. I felt better just letting the migraine run it’s course than I did with the drug. Someone suggested taking 800-1000 mg ibuprofen at the first sign of an attack. I am fortunate that I now get a distinct aura before the full-on attack. I can take the OTC ibuprofen and the migraine never fully develops. Sometimes I need to take an additional dose a few hours later or even the next day. I feel very fortunate this works for me, for now. I have a friend who has much worse events and has tried every drug available and botox. I also take vitamin B2 and magnesium regularly to reduce the number of events.

  • Adam13
    3 years ago

    When my migraines were less frequent and before I actually knew they were migraines (thought sinus), I took Goody’s powder. It worked well if taken very early but I often had to lay down for a couple of hours while it worked its way through my system.

    As my headaches became more frequent my stomach couldn’t tolerate how much Goody’s I was taking. I finally went to the doctor and found out what my real problem was.

    If you don’t have access to a prescription medication Goody’s is worth a try, especially if you know your prodrome symptoms and can take it early in the attack.

  • Tammy Rome author
    3 years ago

    Before getting a triptan Rx, my teenage son took Goody’s “shots” — a single dose liquid version at the first sign of an attack. It was quite effective for many years.

  • Dr. Alex Mauskop
    3 years ago

    Almost half of migraine sufferers have never seen a doctor for their headaches and many of them do not think that they have migraines. If patients who do see a doctor are often misdiagnosed as having sinus or tension-type headaches. They often respond to OTC drugs.

    To toot my own horn, you may want to try a product I developed, Migralex, an OTC headache drug sold in CVS and Amazon.com. In addition to an extra strength dose of aspirin, it contains magnesium, which makes it gentler on your stomach. It has no caffeine, so there is no risk of rebound or medication overuse headaches.

  • Luna
    3 years ago

    This subject goes along with your other post about what is a real migraine. I am one that uses a generic excedrin for migraine. Went through a period of years that I tried every preventative and abortive they could throw at me. Preventatives did not prevent only caused difficult side effects. For abortives Cafergot PB worked best but the PB was dropped and when Cafergot didn’t work, which was too often, it left me feeling worse. Imitrex seemed wonderful but within a short time it only put off the attack for a few hours. I was very episodic then so was not taking it very often. When my job ended that had rx drug coverage then I found Excedrin. It worked better than the rx drugs for me.

    I am always dismayed at the people who comment on here who do not want to accept that some people can control their migraine attacks with OTC’s. All the people I know that use OTC’s will have a full on puke attack if the OTC doesn’t work.

    Back to the “real” migraine. There are many symptoms that are associated with migraine that may not result in “real” pain but are just as real and can really side track a persons body and/or brain. I have both silent and full on puke attacks and either one can last for days.

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