How to Choose the Right Migraine Medication: Part One

medication1

Long, unpronounceable names.

A laundry list of potential side effects.

Generic vs. brand.

Standing in the pain relief aisle at the drug store can be an intimidating experience. There’s enough to ponder even when you’re feeling good. If your head is pounding, the level of difficulty is magnified tenfold.

And while the best strategy is to prevent migraines from ever starting, it’s still critical to be prepared when a headache does strike. When it comes to ending a migraine attack, timing is everything.

But choosing an appropriate headache remedy doesn’t have to be complicated. So let’s make things simple. By the end of this series, you’ll have a simple and easy to follow course of action – one based on my experience with my own migraines and thousands of migraine patients – for choosing the medication with the best odds of success.

To start, I’ll be reviewing the over the counter remedies. As you’ll see from the following discussion, most of these are just different variations on the same theme of aspirin, acetaminophen, ibuprofen, and caffeine, and every drug store will generally carry its own generic alternative to each of the medications listed. None of these attack migraine physiology specifically (despite their marketing), and as such aren’t likely to relieve a full blown migraine.

For some migraineurs, however, if taken early enough in the course of a headache, some over-the-counter medications can keep things from escalating further. Which means that, for some of you, these can still occupy a useful place in your headache relief arsenal.

In this overview, I’ll take each category of over the counter remedy and rate  its overall effectiveness against migraine (on a 1 to 10 scale, with 10 being most effective), list its most notable side effects, and, last but not least, its propensity for causing rebound headaches (a very important topic I’ll cover more soon).

OVER THE COUNTER REMEDIES

1. Acetaminophen (brand name Tylenol)

  •  Effectiveness against migraine: 1
  •  Side effects: liver toxicity at higher doses
  •  Potential for rebound headaches: moderate

 

[message_box color=”blue”]THE VERDICT: Generally avoid – terrible track record against migraine, so not worth the risks. Occasionally helpful for those who are aspirin allergic.[/message_box]

2. NSAIDs – Ibuprofen, Naproxen (brands include Motrin, Advil, Aleve)

  • Effectiveness against migraine: 4.  Success varies from one person to the next – typically only beneficial if taken early in the course of a headache. Not going to abort a full blown attack.
  •  Side effects: stomach upset, bleeding tendency
  •  Potential for rebound headaches: moderate

 

[message_box color=”blue”]THE VERDICT: A reasonable choice for some folks, particularly for a slowly evolving or mild to moderate intensity headache.[/message_box]

3. Aspirin (brands include Ecotrin, Bayer, Bufferin)

  • Effectiveness against migraine4.  Success varies from one person to the next – typically only beneficial if taken early in the course of a headache. Not going to abort a full blown attack.
  •  Side effects: stomach upset, bleeding tendency
  •  Potential for rebound headaches: moderate

[message_box color=”blue”]THE VERDICT: A reasonable choice for some folks, particularly for a slowly evolving or mild to moderate intensity headache[/message_box]

 4. Combination “headache relief” medications with Aspirin and Caffeine (brands include Anacin, BC Powder, Bayer Extra Strength Back and Body Pain)

  • Effectiveness against migraine: 6. Success varies from one person to the next – typically only beneficial if taken early in the course of a headache. In rare cases will abort a full blown attack.
  •  Side effects: stomach upset, bleeding tendency, insomnia
  •  Potential for rebound headaches: high

 

[message_box color=”blue”]THE VERDICT: A reasonable choice for some folks, particularly for a slowly evolving or mild to moderate intensity headache, but only taken occasionally (once per week or less), and only in morning or early afternoon, due to their high potential for rebound and their effects on sleep.[/message_box]

5. Combination “headache relief” medications with Aspirin, Acetaminophen and Caffeine (brands include Excedrin, Excedrin Migraine, Goody’s, Pamprin Max, Anacin Advanced Headache)

  • Effectiveness against migraine: 5. Success varies from one person to the next – typically only beneficial if taken early in the course of a headache. Not going to abort a full blown attack.
  • Side effects: liver toxicity at higher doses, stomach upset, bleeding tendency, insomnia
  • Potential for rebound headaches: high

 

[message_box color=”blue”] THE VERDICT: Generally avoid, as there is no real scenario where they’d be used over medications in the preceding category (combination medications without Acetaminophen), given the inferiority of Acetaminophen to Aspirin (i.e. – extra risk without extra benefit).[/message_box]

So that pretty much covers it for the over-the-counter options. In part 2, I’ll talk about what’s available by prescription, and conclude with an easy to follow approach for making your own individualized, informed choice.

 

1 thought on “How to Choose the Right Migraine Medication: Part One

  1. Still awaiting moderation? It is September 17 2019 and I still say none of those over the counter medications ever worked for my migraine at any time.

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