The Best Over the Counter Migraine Medicine

By Terez Malka, MD
Medically reviewed checkmarkMedically reviewed
April 14, 2022

Migraine is a moderate to severe headache that is caused by neurological changes in the brain. The pain can make it hard to function normally.

When you get a migraine, you don’t want to be caught with severe head pain and no plan of action.

Six out of every 10 people who experience migraine attacks effectively treat their pain with over-the-counter (OTC) pain medicine.

With several options, it can be hard to know which one might work best for you.

This article explores OTC pain relievers, benefits, risks, and how to know when you should see a doctor for help.

What is a Migraine?

People may use the term “migraine” to mean a really bad headache.

However, a migraine is more than just head pain.

It is a neurological condition that affects 1 in 7 Americans.

Migraine pain is caused by blood vessels that swell in the brain.

Symptoms

Symptoms of a migraine attack tend to be felt on one side of the head or behind the eyes.

The pain may be described as severe, pulsing, throbbing, or pounding.

Migraine attacks can last for a few hours or up to 3 days, and may make it hard to function normally.

Common symptoms of migraine episodes, besides head pain, include:

Causes

Anyone can get a migraine, even children.

But some factors make them more likely, including:

  • Genetics and family history
  • Sex (people born with vaginas are more likely to be affected)
  • Stress
  • Certain foods (red wine, chocolate, artificial sweeteners, MSG, preservatives, and others)
  • Too much or too little caffeine
  • Sensory overstimulation with bright lights or loud noises
  • PMS
  • Barometric weather changes
  • Tobacco or alcohol
  • Lack of sleep
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Over-the-Counter Medications for Migraine Attacks

There are many over-the-counter medications for migraine attacks.

One may work better for one person than others, and an option that combines different medications may be more effective.

Read on to learn about the OTC pain medications, how they work, benefits, and potential risks.

Ibuprofen (Advil, Motrin)

Ibuprofen (Advil, Motrin) is an NSAID (nonsteroidal anti-inflammatory drug) that works to decrease inflammatory causes of pain.

For migraine, the pain in the head comes from blood vessels that swell from inflammation.

  • Dosage: Can range from 200 mg to 800 mg every 6-8 hours, or as directed by a medical provider. Higher dosages can be given by prescription. For most adults, 400mg every 6 hours or as needed is an effective dose.

Benefits

Ibuprofen works to inhibit specific enzymes that make compounds called prostaglandins.

These compounds are what cause pain and swelling in many conditions, including migraine.

Ibuprofen may be effective as a migraine pain reliever for approximately half who try it.

Potential risks

Ibuprofen increases the risk of stomach bleeding, especially with regular use at higher doses.

It may also not be indicated for people who have high blood pressure, heart problems, ulcers, or other gastrointestinal disorders where bleeding may already be a side effect.

Naproxen (Aleve)

Naproxen (Aleve) is an NSAID that is also available in prescription form (Naprosyn) at a higher dose.

Naproxen works the same way that ibuprofen and aspirin do, by inhibiting the enzymes that stimulate production of prostaglandins.

  • Dosage: 220 mg every 8-12 hours, but may take 2 tablets within the first hour, not to exceed more than 3 capsules in a 24-hour period.

Benefits

Naproxen can be an effective OTC pain reliever, but some research finds that ibuprofen may be more effective at treating migraine-related pain than naproxen.

This may be due to the fact that naproxen takes longer to take effect.

Some medical providers may recommend naproxen in combination with sumatriptan, a prescription pain reliever for migraine.

Do not take multiple pain medications together unless directed to do so by your healthcare provider.

Potential risks

Naproxen carries the same risks as ibuprofen and other NSAIDs.

People who have stomach ulcers, bleeding issues, or cardiovascular problems should not take naproxen as they may experience serious side effects.

Aspirin

Aspirin is an NSAID pain reliever.

It works by blocking enzymes that make prostaglandins, which can trigger pain and inflammation responses with migraines and other problems.

  • Dosage: Aspirin products are available in many different dosages. OTC aspirin for migraine relief is typically taken at doses of 200-325 mg. For acute migraine, your healthcare provider may recommend a single dose of 1,000 mg of aspirin which has comparable effects to sumatriptan, a prescription pain reliever for migraines. You should not do this unless directed by a medical provider.

Benefits

Aspirin can be an effective pain medication for many conditions including migraines.

It is considered a first-line migraine treatment when used in combination with acetaminophen and caffeine.

Potential risks

Like other NSAIDs, aspirin comes with a risk of stomach bleeding.

It can also worsen acid reflux.

Aspirin should never be taken by anyone under age 19, as it can cause a serious, potentially life-threatening condition known as Reye’s syndrome.

Acetaminophen (Tylenol)

Acetaminophen (Tylenol) is an analgesic pain reliever.

Unlike other OTC pain relief medication for migraines, acetaminophen is not an NSAID.

Tylenol still has a similar effect on the cause of migraine pain.

It blocks prostaglandins from increasing inflammation and causing pain, but does not reduce inflammation.

  • Dosage: 325-650 mg every 4-6 hours, not to exceed more than 3,000 mg in a 24-hour period unless directed by a physician.

Benefits

Acetaminophen is better than placebo for acute migraine headache relief.

However, it may not work as effectively as other OTC pain relievers.

It is a good option for anyone who cannot take NSAIDs because of bleeding risks.

It can be an especially effective treatment when combined with aspirin and caffeine.

Potential risks

Acetaminophen comes with risks for liver health.

If you take too much in a 24-hour period, it can cause severe liver damage.

For people who already have liver conditions or disease, acetaminophen should be avoided.

Consuming acetaminophen if you also have more than 3 alcoholic beverages per day may also increase the risk for liver problems.

“OTC Migraine Cocktail”

An OTC “migraine cocktail” refers to a combination of medications that work safely together to address migraine pain.

Excedrin is an OTC pain reliever that combines 250 mg of aspirin, 250 mg of acetaminophen, and 65 mg of caffeine.

While aspirin and acetaminophen can work to reduce prostaglandins that cause inflammation, pain, and swelling, caffeine can trigger the blood vessels in the brain to tighten up.

Migraine pain in the head is driven by dilated blood vessels that increase pressure.

By causing blood vessels to shrink, caffeine can help to alleviate migraine pain.

This combination of medications is considered a first-line treatment for migraine headaches and may be more effective than using a single medication.

Experiencing migraines? Chat with a medical provider through K Health.
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When to See a Doctor for Migraines

If OTC pain medication does not alleviate pain from migraines, or if you have frequent moderate to severe migraine attacks, you should see a healthcare provider.

They can run tests to determine the cause of your head pain.

If it is truly migraine attacks, they can prescribe stronger pain medications or even different types of medications that can prevent the recurrence or frequency of migraine episodes.

Frequently Asked Questions

What is the best medicine for migraine?
There are several effective medications for migraine, both OTC and by prescription. What is most effective for you may not be as effective for someone else. For OTC pain relief, a mixed medication like Excedrin Migraine, which contains acetaminophen, aspirin, and caffeine, is one of the most effective migraine medications. NSAID medications like ibuprofen can also be very effective., If you cannot take NSAIDs for health reasons, acetaminophen at a dose of 1,000 mg has been found comparable to some prescription-only pain medication and can be combined with caffeine. If you are experiencing frequent or severe migraines that do not respond to over-the-counter medications, there are many prescription options. Sumatriptan (Imitrex) or other medications in that family are a commonly prescribed option. Your healthcare provider will choose a medication for you based on your symptoms, your age, your overall health, and interactions with drugs that you already take.
What can you take over the counter for a migraine?
There are several OTC options available for migraine relief, including aspirin, naproxen (Aleve), ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and Excedrin Migraine.
What is the quickest way to get rid of a migraine?
If you have pain relief medication, you should take it at the first sign of a migraine. You can also find faster relief by lying down in a dark, quiet room, avoiding stimulating lights or sounds, and by using warm compresses, or taking a warm bath or warm shower to address tense muscles.
What is the strongest over the counter headache medicine?
The strength of OTC medication you take depends on the dose. Each medication has its own dosing, and you should always follow the instructions that come with the medication or your medical provider’s advice. Excedrin pairs acetaminophen, aspirin, and caffeine, which may be a more effective migraine reliever if you find that ibuprofen, naproxen, or acetaminophen alone do not address your pain.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

Terez Malka, MD

Dr. Terez Malka is a board-certified pediatrician and emergency medicine physician.

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