Picking the Best OTC Headache Relief Medication is Such a Pain in the …

We’ve all been there: You have a headache that won’t go away and you have other things to do! 

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So, what do you reach for first? Coffee? Excedrin? Aleve? Midol?  What's the best headache medication?

Before you choose what to use for your headache relief, here are some things to consider: Are you taking a blood thinner like warfarin, Eliquis, Xarelto, Pradaxa, or Savaysa? Do you have an upcoming surgery scheduled? Are you already taking a daily aspirin? Do you have a history of peptic ulcers or gastritis? Are you pregnant? How often are you having these headaches?Close up of man holding a pill and glass of water in bright living room.jpeg

If you’re taking a blood thinner many of the OTC medications that are sold for headache and pain relief can increase your risk of having a serious bleeding problem like bleeding in your stomach, intestines, or brain. Aspirin is particularly risky when taken in larger doses than the 81mg for heart health. When it’s used as a pain reliever the dose is between 200-1000 mg (if you take 2 tablets). These higher doses can result in liver toxicity, and gastrointestinal problems in as many 30-90% of people with pre-existing peptic ulcer or gastritis.

Aspirin is included in many common OTC products such as:

  • Goody’s, Midol, Pamprin, Excedrin, Bayer Migraine, BC powder, and Alka-Seltzer to name a few.
Eating along with the medication won’t decrease your risk either. The risk of having a serious bleeding problem increases with age. This risk includes the use of aspirin, ibuprofen, and naproxen and the benefit of using these medications should be carefully weighed against their risks before using them.

If you have any scheduled surgery coming up, the use of aspirin, ibuprofen, naproxen and other blood thinners are generally recommended to be stopped a week beforehand.  You should check with your doctor beforehand.

If you’re pregnant the only safe OTC medication for headache relief is acetaminophen regular strength (Tylenol 325mg). Medications that contain aspirin or NSAIDs like ibuprofen and naproxen can cause serious harm in the third trimester and should be avoided.

If you’re considering using a caffeine-containing medication like Excedrin, here’s some things to know.

  • Caffeine has been shown to cause rebound headaches if over-used, so consider how often you’re using a caffeine-containing medication and how much caffeine you drink. 
  • Caffeine can cause an increase in heart rate, and should be avoided in people with cardiac arrhythmias, angina, or a recent history of heart attack. 
  • Caffeine can increase anxiety, worsen insomnia, and cause a variety of gastrointestinal effects.
Gosh, maybe I should stop using caffeine!

As always, the best way to use any medication for headache relief is to thoroughly read the labeling and instructions for use before taking it.


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