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Over-the-counter Drugs Do the Job for Many

To determine whether over-the-counter (OTC) drugs are effective for migraine, three recent studies looked—and found—evidence that aspirin, acetaminophen and naproxen significantly reduce the pain of migraine attacks.

The first study looked at aspirin. Though commonly used by headache sufferers, its usefulness for migraine has been unclear. The systematic review of 13 clinical trials found that high doses are significantly more effective than placebo and may work as well as the triptan sumatriptan. A single dose of 900 to 1,000 mg reduced head pain within two hours for 52% of people vs. 32% of those on placebo. One quarter were pain-free, compared to 11% on placebo. These findings were comparable to 50 mg of sumatriptan, though 100 mg of the triptan gave better results. Combining aspirin with the anti-nausea medication metoclopramide further increased the reduction in nausea and vomiting.

“Aspirin plus metoclopramide will be a reasonable therapy for acute migraine attacks, but for many it will be insufficiently effective,” wrote study author R. Andrew Moore, DSc, in a written release.

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In another analysis of studies, naproxen (Aleve®) reduced the pain of moderate-to-severe migraine and associated symptoms within two hours, similar to the triptan frovatriptan, but not as effectively as almotriptan or zolmitriptan. The researchers also noted in the journal Headache that naproxen “appears to be inferior” to 1,000 mg of aspirin.

Lastly, acetaminophen (Tylenol®) proved itself beneficial for migraine treatment at the 1,000 mg dose. As with aspirin, 52% of those taking acetaminophen reported that their pain had been diminished. They also experienced significantly higher relief from nausea and noise sensitivity as compared to placebo. The small study, which was funded by McNeil Consumer Healthcare, the maker of Tylenol, did not compare the drug to any triptans.

(Editor’s note: Currently, Excedrin® is the only branded OTC drug that has received FDA approval for migraine. One reason other OTC drugs have not received approval is that in large placebo-controlled studies they relieved pain, but not other associated migraine symptoms, such as nausea and sensitivity to lights or noise. Remember, if overused, OTC drugs may lead to rebound headache in addition to other side effects. Children under 12 should avoid taking aspirin because it is associated with a rare, but serious condition called Reye’s Syndrome.)

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