Acute Over-the-Counter Medicines (non-prescription medicines)


Over-the-Counter medicines are commonly referred to as "non-prescription medicines". They include pain relievers (or analgesics). These medicines can be used to treat milder headaches.

They are readily available and do not require a prescription.

They are safe and effective when patients use as prescribed (and dosage amounts) or as suggested by your physician, pharmacist or by following the instructions on the label.

Keep in mind that they are not a cure and are recommended to relieve symptoms and/or shorten your illness.

Acetaminophen (Tylenol®, or generic)

Acetaminophen belongs to a group of medicines called analgesics (pain relievers). This over-the-counter drug has been found to reduce fever and effectively treat headaches (and other pain problems). It can be used to treat both tension-type headaches and mild-to-moderate migraines.

Acetaminophen is usually known by the common brand name Tylenol®. and Extra Strength Tylenol®.

In a 2015 interview with Chatelaine Magazine, Dr. Christine Lay, a headache neurologist and director of the Centre for Headache at Women’s College Hospital in Toronto suggests "Acetaminophen is a reasonable first step for taming mild tension-type headaches." However, it may not be quite as effective as non-steroidal anti-inflammatory drugs (NSAIDs) for migraine relief (see Acute Treatments next section). 1

There are many brands and forms of acetaminophen and if seeing your physician is not possible, advice can be obtained from any pharmacist. It can be purchased over-the-counter from drug stores, grocery stores, convenience stores, virtually anywhere.

Most people that use acetaminophen experience no side effects and reactions are exceedingly rare. 2

A dose of 4g per day (or 8 extra strength Tylenol) should not be exceeded due to risk of liver injury. It is important to note that many cough and cold products often contain acetaminophen. Be careful to read the labels and not exceed recommended doses of acetaminophen.

Non-Steroidal Anti-Inflammatory Drugs (NSAID)

Ibuprofen (Advil, Motrin or generic)

According to Wikipedia, "Ibuprofen is a medication in the non-steroidal anti- inflammatory drug (NSAID) class that is used for treating pain, fever, and inflammation". 3

Scientists have concluded that it works by blocking chemicals in your body that are responsible for inflammation.

Common brands of ibuprofen include: Advil; Advil Migraine; and Motrin.

Ibuprofen is relatively safe, and has been used to treat children with migraines. Side effects reported include: stomach upset, nausea and/or vomiting (note: these are also features of a typical migraine), and rarely stomach or intestinal bleeding, and allergies.

Dr. Rose Giammarco, from the Hamilton Headache Centre, at McMaster University, in Hamilton, Ontario, has further noted that ibuprofen is a relatively safe treatment for Menstrual Migraines, or women who are pregnant, or wanting to become pregnant, but should be avoided in the third trimester.

Naproxen Sodium (Aleve or generic)

Naproxen is a non-steroidal anti-inflammatory drug (NSAID) that is used to treat pain, fever and swelling (inflammation). The brand name most commonly associated with Naproxen is Aleve. Generic versions of naproxen are also available.

In an interview with Chatelaine Magazine, Dr. Christine Lay from Toronto, Ontario suggests.... "this NSAID is longer acting than ibuprofen. "If you have a headache that tends to linger for a few hours, naproxen might be a better choice," Lay says. It’s less likely than acetaminophen to promote medication-overuse headaches (headaches that can occur if you regularly take pain medication more than twice a week) because you generally need to take fewer pills for relief." 4

It is believed to work by stopping the production of chemicals that produce inflammation. Mild side-effects reported include stomach upset stomach, nausea, and heartburn. Serious side effects include stomach and intestinal bleeding (rare) and allergies.

Acetylsalicylic Acid (ASA) or Aspirin

Acetylsalicylic acid (ASA) belongs to the group of medications called analgesics (pain relievers). 5

It is very useful for treating fever, and pain. It has an anti-inflammatory activity at higher doses.

It is also known for its anti-clotting properties and it helps to prevent blood clots by thinning your blood. Acetylsalicylic acid is known as Aspirin. Aspirin comes in a verity of forms including Aspirin coated; Aspirin extra strength; Aspirin chewable; and others. The dose of 81 milligrams is used in people with a risk of heart attack as a preventative medicine. Patients that use acetylsalicylic acid (ASA) for headache/migraine prevention generally require higher doses such as 500 mg or 1g. Chewing two Aspirin 81 mg tablets is recommended if a person is experiencing a heart attack.

Side effects reported include stomach upset, heartburn and indigestion. Serious side effects include stomach or intestinal bleeding (rare). Allergies can also be serious and ASA should be avoided in children under 16 years of age due to a risk of Reye’s Syndrome.

Combination Products

Analgesic combination products contain either one or more types of analgesics with other medicines. The different analgesics generally have different modes of action and work simultaneously to reduce pain. 6

These combinations usually contain acetaminophen or ASA plus caffeine and some may also contain butalbital (a barbiturate) and codeine. Products containing butalbital and codeine are not ideal for treating migraine because there is a risk of dependence, addiction and medication overuse headache with frequent use.

* see the interview on OTCs from Chatelaine Magazine, with headache specialist Dr. Christine Lay from the Women’s College Hospital, in Toronto, Ontario

REFERENCES - Over-the-Counter

  1. Chatelaine Magazine - interview with Dr. Christine Lay, Toronto - OTCs, April 2015
  2. WebMD - Side-effects of Acetaminophen
  3. Wikipedia - ibuprofen definition
  4. Chatelaine Magazine - interview with Dr. Christine Lay - OTCs - April 2015
  5. - Acetylsalicylic acid (ASA), brand name Aspirin
  6. - Analgesic Combinations

If you take OTCs as soon as your symptoms appear, you can get relief within an hour or two depending on the severity of your headache. "The longer you wait, the worse your headache will get and the less likely your medicines will be helpful." Dr. Christine Lay, Headache Neurologist, Toronto, ON. Interview: Chatelaine Magazine

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The book Chronic Daily Headache features
an article reviewed by a Headache Neurologist
entitled "Why Some Headache Patients do
not Improve"!