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Article | Over-the-Counter
Medications for Migraine . . . .
Virtually
every human being has experienced a headache at some point
during his or her life. The majority of individuals can successfully
treat their infrequent headaches with simple measures such
as ice packs to the forehead or resting quietly for a short
period of time. However, in the United States 45 million people
suffer with recurrent headache pain, requiring therapy beyond
just simple measures. Of these people, 28 million contend
with migraine attacks. The most common remedy utilized by
migraine patients for an attack is an over-the-counter (OTC)
product. Indeed, 6 out of 10 migraine patients, or 16 million
people, exclusively use OTC medications as treatment.
A number of factors
foster the widespread use of OTC agents. First, these drugs
can be purchased in a variety of locations including community
pharmacies, supermarkets, and convenience stores, among others
locales. Second, these products are inexpensive and can be
easily obtained without the time and money required tovisit
a physician. Third, these medications are safe and, when used
according to directions, cause harm only in rare instances.
Lastly, heavy advertising via television and magazines, among
other mediums, creates consumer demand for these products.
The proper role
of OTC products in the overall management of migraine needs
to be recognized since OTC agents are not appropriate for
every migraine sufferer. The most significant point is that
OTC products have not been shown to be beneficial to people
who lose the ability to function with the majority of their
attacks. Loss of function is illustrated by any of the following;
the need for bed rest, vomiting, or the inability to perform
usual work, school, or household activities. Furthermore,
migraine attacks that reduce by one-half or more a person’s
ability to perform normally in work, school, or household
should also be considered loss of function. People who experience
this degree of incapacity with the majority of their attacks
most likely require prescription medication and should seek
the assistance of a physician. The National
Headache Foundation (NHF) (www.headaches.org) maintains
a state-by-state list of physicians who focus on headaches.
Patients can obtain this list for free by contacting the NHF.
Currently in this
country three products have the approval of the Food and Drug
Administration (FDA) for the treatment of migraine attacks;
Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain™.
All three products have been shown effective for mild to moderate
migraine attacks.
Excedrin Migraine
was the first to received FDA approval. This is a combination
product, which contains 250mg of aspirin, 250mg of acetaminophen,
and 65mg of caffeine per tablet. The recommended dose for
people over 18 years of age is two tablets at the onset of
an attack, not to exceed two tablets in a 24-hour period.
Advil Migraine and
Motrin Migraine Pain both contain 200mg of ibuprofen, however,
Advil Migraine is a gel formulation, which may help absorption.
The recommended dose of Advil Migraine in adults is two capsules
at the onset of an attack, not to exceed two capsules per
24 hours. For Motrin Migraine Pain, the recommended dose in
adult is one or two caplets at the onset of an attack, not
to exceed two caplets per 24 hours.
Other OTC medications,
though not specifically FDA approved for migraine, may also
be useful for mild to moderate migraine attacks, including
aspirin, acetaminophen, and naproxen. Patients should follow
the dosage recommendations listed on the box.
No OTC product has
been shown superior or inferior to another OTC product and
selection normally depends on patient preferences. Regardless
of which medication is tried first, patients with mild to
moderate migraine should treat a minimum of three attacks
with that particular drug. If that product fails to provide
acceptable relief in the at least 2 of 3 attacks (i.e. the
majority), then patients should switch to a different agent.
People who fail to obtain relief after adequate trials of
two or more OTC products should seek the help of a physician.
"Relief" can be defined as the ability to return
to normal activities free of pain.
Limitations of use
for OTC products are extremely important. Many patients mistakenly
believe that more frequent consumption will provide greater
headache relief. This escalation of drug consumption typically
develops over many months, sometimes years, thus patients
may not fully realize just how often they are using their
OTC medication.
Approximately 10
million people suffer with chronic headaches (15 or more days
with headache per month). The number one cause of chronic
headaches is over-use of "painkiller" medications,
including OTC products. As directed on the label, patients
should not use more than one dose of an FDA approved migraine
drug per 24 hours. Patients who feel the need to use an OTC
product three or more days per week are at risk of developing
chronic headaches. Such patients should consult a physician.
Detection and evaluation of people with excessive OTC drug
use near the beginning of their over-use is important since
the chances of successful treatment are best with early intervention.
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