Key takeaways:
Common over-the-counter (OTC) migraine medications include acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs), and caffeine — either alone or in combination products such as Excedrin Migraine (acetaminophen / aspirin / caffeine).
Combination migraine products may relieve pain faster than single-ingredient products, but they carry a higher risk of side effects and drug interactions. The best option for you depends on your personal history and other medications you’re taking.
Using OTC migraine meds too often or at higher-than-recommended dosages can cause rebound headaches. Talk to your healthcare team if you need them more than twice a week.
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When a migraine hits and you need quick relief, you might head to a pharmacy. But as you’ll quickly realize, there are a lot of migraine medications on the shelves. So how do you know which one to pick?
Learn which active ingredients you should look for in over-the-counter (OTC) migraine medicines, as well as their risks and side effects to consider.
Common OTC migraine medication ingredients
There are a handful of ingredients you can expect to see on the label of an OTC migraine medication. They all target the main symptom of a migraine: head pain.
Common ingredients in OTC migraine medications include:
Acetaminophen (Tylenol)
Ibuprofen (Advil, Advil Migraine, Motrin)
Naproxen (Aleve)
Caffeine
You can find these ingredients on their own, such as Advil Migraine. They also come in different combinations as one pill, such as Excedrin Migraine or Goodys Headache Powder (acetaminophen / aspirin / caffeine).
With all these options, it can be difficult to know which one to choose. Here, we’ll look at how these ingredients differ when it comes to how long they take to work, how much you need to take, and potential risks.
1. Acetaminophen
Acetaminophen is a pain reliever that works well for migraines. It’s thought to work by blocking certain brain chemicals that make you sense pain.
Onset: When you take acetaminophen by mouth, it usually starts working within 15 to 60 minutes. And it may work faster on an empty stomach.
Natural migraine remedies: Prescription and over-the-counter medications are often effective for migraine relief. But if you’re interested in natural and home remedies, check out this review from experts to see which ones might be worth a shot.
Real-world migraine stories: When a migraine hits, it can affect your ability to work and do your normal day-to-day activities. Read about how three people living with chronic migraines manage their symptoms every day.
Advil Migraine vs. Excedrin Migraine: Both products can help provide migraine relief, but is one better than the other? Here’s how Advil Migraine and Excedrin Migraine compare.
Dosage forms: Acetaminophen is available in doses ranging from 325 mg to 650 mg. This includes tablets and capsules, an oral liquid, and powder packets. Combination products like Excedrin Migraine typically contain 500 mg of acetaminophen per dose (2 tablets). How often you take it depends on which dosage form you’re taking.
How much you can take: Each acetaminophen product has a maximum recommended daily dosage on the label. For adults, this is usually 3,000 mg to 4,000 mg of acetaminophen in a 24-hour period. Keep track of this amount to avoid taking too much, especially if you’re taking multiple products with acetaminophen. If you have a higher risk of liver damage, your healthcare team may recommend a lower amount.
Potential risks: Acetaminophen can damage your liver, especially if you take too much. This can be particularly risky if you have liver problems or if you have more than 3 alcoholic drinks per day. In this case, ask your healthcare team before taking it.
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2. Ibuprofen
Ibuprofen belongs to a group of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by blocking the effects of cyclooxygenase (COX), an enzyme (protein) that’s involved in causing inflammation.
Onset: For migraine pain, ibuprofen should start working within 30 minutes, but it may take up to 2 hours to feel relief.
Dosage forms: For adults, OTC ibuprofen is available as 200 mg tablets, capsules, and soft gel capsules (Liqui-Gels). It also comes as a liquid suspension. Of the available dosage forms, the soft gel capsules may work the fastest. Higher-dose forms of ibuprofen are also available, but only by prescription.
How much you can take: For most people, the maximum recommended amount of OTC ibuprofen is 1,200 mg (six 200 mg tablets) daily. But Advil Migraine limits the dosage to no more than 2 capsules (400 mg) in 24 hours. That’s to prevent rebound headaches, which we’ll cover later.
Potential risks: Short-term NSAID use isn’t usually a big deal for most people. But long-term or high-dose ibuprofen has several risks. These include an increased risk of heart attack and stroke, stomach bleeds, and kidney damage. If you have a history of these conditions, check with your healthcare team before taking ibuprofen.
3. Naproxen
Naproxen is another NSAID available OTC for migraine pain. But some research suggests that naproxen may not work very well for migraine pain.
Onset: For migraine pain, naproxen may start providing relief within 30 minutes to 1 hour of taking a dose. Compared with ibuprofen, naproxen lasts longer in your body. In general, you typically need to take it less often throughout the day.
Dosage forms: OTC naproxen is available as 220 mg tablets, capsules, and soft gel capsules. Higher-dose forms of naproxen are also available with a prescription.
How much you can take: Unless otherwise directed, you shouldn’t take more than 440 mg (2 tablets) of naproxen at once. And you shouldn’t take more than 660 mg (3 tablets) in a 24-hour period.
Potential risks: Naproxen has similar risks as ibuprofen, and it can also be harder on your stomach. So it’s best to check with your healthcare team before taking naproxen to ensure it’s safe for you.
4. Aspirin
Like ibuprofen and naproxen, aspirin is an NSAID. It’s available OTC and with a prescription. Aspirin seems to be effective for both relieving migraine pain and preventing recurrent migraines. But you shouldn’t take it on a regular basis unless your prescriber tells you to.
Onset: For migraine pain, aspirin typically starts working within 30 minutes of taking it.
Dosage forms: OTC aspirin is available in dosages ranging from 81 mg to 650 mg. The 81 mg tablets (also called low-dose aspirin) are typically used to help prevent blood clots. So you’ll typically take higher doses for migraine pain. OTC combination migraine products with aspirin typically contain 500 mg per dose (2 tablets).
How much you can take: You shouldn’t take more than 3,900 mg of aspirin in a 24-hour period. Taking too much aspirin can result in a serious condition called salicylate toxicity. Symptoms include rapid breathing, confusion, and ringing in your ears. Be sure to follow the recommended dosing on your product’s label to minimize this risk.
Potential risks: Aspirin doesn’t have the same cardiovascular risks as other NSAIDs. But it can increase the risk of bleeding and kidney problems. Aspirin is also linked to a life-threatening condition called Reye’s syndrome. People under age 19 should avoid taking aspirin, since Reye’s syndrome is more common in this age group.
5. Caffeine
Caffeine is found in both OTC and prescription migraine medications. It’s thought to work by blocking a chemical in the brain to help lower pain sensations. And it may boost the effects of other OTC migraine medications (such as acetaminophen or aspirin) when they’re combined.
But caffeine can also trigger migraine headaches for some people. And if you already regularly consume caffeine, it may not be as effective for migraine pain relief.
Dosage forms: OTC combination migraine products typically contain 130 mg of caffeine per dose (2 tablets). This is roughly the amount of caffeine in a cup of regular drip coffee. Caffeine is also available in OTC products such as NoDoz or Vivarin that typically contain 200 mg per tablet.
How much you can take: There isn’t a set maximum amount of caffeine that’s considered safe. Most experts recommend limiting caffeine to 400 mg or less per day, unless otherwise directed by a healthcare professional. Keep in mind that this includes the caffeine you consume in food and drinks, not just what you take in an OTC product.
Potential risks: Caffeine can increase blood pressure. It can also interact with some other medications. So it’s a good idea to talk with your healthcare team to make sure a migraine medication that contains caffeine is a safe option for you.
Which OTC migraine medication works best?
All the ingredients mentioned above are considered effective options for treating migraine pain. But there’s some evidence that naproxen may not work as well as other treatments.
Research also suggests that the combination of acetaminophen, aspirin, and caffeine may work better and faster than ibuprofen for migraine pain. But keep in mind that taking more than one ingredient can increase your risk of side effects. And it’s a good idea to check with your pharmacist or prescriber to ensure that all these ingredients are safe for you, based on your medical history and other medications.
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Risks and side effects of OTC migraine medications, and who should avoid them
We’ve covered several of the risks of each active ingredient. But there are a few others that you should know about.
Rebound headaches
Rebound headaches (or medication overuse headaches) can happen with OTC migraine medications. They’re more likely if you take more than the recommended dose or more often than 10 days per month.
If you’re taking an OTC migraine medication twice a week or more, ask your healthcare team about preventive treatment options. These medications can help reduce how often migraines occur.
Interactions
OTC migraine medications may interact with other medications you’re taking. For example, NSAIDs can interact with blood thinners, certain blood pressure medications, and diuretics. And caffeine can also interact with medications. Your pharmacist can review your medication list to flag potential interactions.
Medical conditions
If you have certain medical conditions, some OTC migraine medications may not be safe for you to take. For example, NSAIDs aren’t the best option for those living with high blood pressure, heart problems, and kidney disease. And acetaminophen isn’t recommended for those living with liver problems or who drink alcohol regularly. Ask your healthcare team which OTC migraine options may be safest for your particular situation.
Frequently asked questions
Allergy symptoms occur when the body releases histamine in response to an allergen, such as pollen. There’s some evidence that histamine also plays a role in migraine headaches. So in theory, antihistamines — allergy medications that block histamine — may also help treat migraines. But in clinical studies, this doesn’t seem to be the case. Allergy medications aren’t likely to help with a migraine unless it’s an allergy-related headache. But in this case, a decongestant, an antihistamine, or a nasal steroid spray are all effective treatment options.
Cluster headaches are painful headaches that typically affect one side of the head. Oxygen therapy is an effective treatment option for cluster headaches. Triptans are also effective treatments. For preventing cluster headaches, the most commonly prescribed medications are verapamil and corticosteroids.
Allergy symptoms occur when the body releases histamine in response to an allergen, such as pollen. There’s some evidence that histamine also plays a role in migraine headaches. So in theory, antihistamines — allergy medications that block histamine — may also help treat migraines. But in clinical studies, this doesn’t seem to be the case. Allergy medications aren’t likely to help with a migraine unless it’s an allergy-related headache. But in this case, a decongestant, an antihistamine, or a nasal steroid spray are all effective treatment options.
Cluster headaches are painful headaches that typically affect one side of the head. Oxygen therapy is an effective treatment option for cluster headaches. Triptans are also effective treatments. For preventing cluster headaches, the most commonly prescribed medications are verapamil and corticosteroids.
The bottom line
Acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs), and caffeine are common ingredients found in over-the-counter (OTC) migraine medications. You can buy them on their own or in combination products, such as Excedrin Migraine (acetaminophen / aspirin / caffeine). Combination products may work better and faster than single-ingredient options. But they come with more side effects and interactions to consider.
If you’re considering an OTC migraine medication, a pharmacist can help you determine which products may be best for you. Taking OTC migraine medication too often or at a higher-than-recommended dose can lead to rebound headaches and other issues. If you’re taking an OTC migraine medication more than twice a week, let your healthcare team know. You may need a preventive migraine medication.
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References
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Kandel, S. A., et al. (2023). Cluster headache. StatPearls.
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