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Treating Migraine : Over-the-counter Pain Relief

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Q: What medications can I purchase without a prescription to relieve the pain of a migraine attack?
A: Several over-the-counter medications called analgesics can relieve the pain of the headache during a migraine attack. Many analgesics consist of acetaminophen alone and are known as simple analgesics. Others may be a combination of aspirin or acetaminophen with caffeine, decongestants, and/or antihistamines. These combination analgesics are marketed for migraine, tension headache, or sinus headache. In countries outside the US, you can buy analgesics with a mix of acetaminophen and codeine.
Q: What do I need to know about the use of analgesics for my migraine attacks?
A: Analgesics are nonspecific medications and should only be used for the treatment of a migraine attack when more specific medications cannot be used. If you do use analgesics to relieve the pain of a migraine attack, you must not use them more than once a week or you might develop medication overuse headache.
Q: Why do companies market so many over-the-counter drugs for different types of headache?
A: Headache is a very common ailment so it has a large consumer market. There are many heavily advertised brand-name products for those suffering from different types of headache. People who have headaches with neck tightness are sold a tension headache pill. If they have headaches over the forehead associated with congestion, they are sold a sinus headache pill. These brand-name products can be expensive and often contain compounds (such as caffeine, decongestants, or antihistamines) not needed to treat a migraine headache. It is important that you have a correct diagnosis for your headache so that you can avoid unnecessary medication and expense.
Q: Is it enough just to stop the pain of an attack?
A: As discussed earlier, abortive therapy is very important, so medication used to treat an attack must be effective. It is not enough to decrease the pain. You must completely stop the attack. Nonspecific medications simply treat the symptoms rather than the underlying cause and increase vulnerability to medication overuse headache.

Nonspecific over-the-counter treatment

To relieve the pain of a migraine attack you can use acetaminophen alone (a simple analgesic) or acetaminophen combined with other drugs (a combination analgesic).

Simple analgesics:

Acetaminophen is an over-the-counter analgesic for pain relief. When you can’t use aspirin or other NSAIDs due to illnesses or pregnancy, acetaminophen alone, or in a combination analgesic, can treat migraine pain. The use of prescription migraine abortive therapy is needed if you use analgesics more than 3 times a month.

Typical dosage:
  • Acetaminophen 650mg

Combination analgesics:

Some combination analgesics contain caffeine, aspirin, and/or a mild opioid and are marketed for tension headache. Others contain diphenhydramine (an antihistamine) or decongestants and are marketed for sinus headache. The combination analgesics with a mild opioid such as codeine are not available over the counter in the US. By combining the medications each drug enhances the effect of the others, providing better pain relief. The most popular over-the-counter combination analgesics in the US are those that contain acetaminophen, caffeine, and aspirin. However, this type of drug is one of the leading causes of medication overuse headache.

Typical dosage:
  • Aspirin 325mg, caffeine 40mg, and acetaminophen 325mg

  • Acetaminophen 325mg, caffeine 40mg

  • Acetaminophen 325mg and diphenhydramine (an antihistamine) 25mg

  • Acetaminophen 325mg and different products containing decongestants

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