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.