Excedrin for migraine
Excedrin is a common over-the-counter (OTC) painkiller specifically advertised for migraine; but what is it? Excedrin is the trade name for the combination treatment of 250 mg of acetaminophen, 250 mg of aspirin, and 65 mg of caffeine. This formulation treats migraines by utilizing a synergistic effect where each component plays a distinct role. Acetaminophen and aspirin act as pain relievers and anti-inflammatories by blocking the production of prostaglandins, while the caffeine serves as a vasoconstrictor to narrow dilated blood vessels in the brain and accelerates the absorption of the medication, making it work faster and more effectively than the analgesics would on their own. Caffeine has been establish to be useful in the treatment of migraine; however for some it may exacerbate headaches.1 There have been various randomized clinical trials establishing the efficacy and safety of Excedrin.2,3
Regarding dosing and limits, the standard adult recommendation is to take two tablets (with a 8 fl oz of water) at the onset of symptoms It is vital to limit the use of this medication to no more than two days per week. Exceeding this frequency can lead to medication overuse headaches, a paradoxical phenomenon where the very medicine intended to provide relief actually triggers a cycle of chronic daily pain. The definition of medication overuse headache (MOH) in the setting of OTC combination treatments is more than 12 times a month (over the span of at least 3 months)
The side effects of Excedrin are often tied to its caffeine and aspirin content, commonly manifesting as jitteriness, insomnia, or gastrointestinal upset. More serious risks include the potential for stomach bleeding due to the aspirin or liver toxicity from the acetaminophen, particularly if the medication is combined with alcohol or other drugs containing similar ingredients. Chronic prolonged acetaminophen use is slowly rising to be a lead contender for liver failure in the United States; moreso in women.4 Click here to book a consultation visit to explore more headache and migraine treatments.
References:
1. Zduńska A, Cegielska J, Zduński S, Domitrz I. Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature. Nutrients. 2023 Jul 17;15(14):3170. doi: 10.3390/nu15143170
2. Lipton RB, Stewart WF, Ryan RE Jr, Saper J, Silberstein S, Sheftell F. Efficacy and safety of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain: three double-blind, randomized, placebo-controlled trials. Arch Neurol. 1998 Feb;55(2):210-7. doi: 10.1001/archneur.55.2.210
3. Diener HC, Gaul C, Lehmacher W, Weiser T. Aspirin, paracetamol (acetaminophen) and caffeine for the treatment of acute migraine attacks: A systemic review and meta-analysis of randomized placebo-controlled trials. Eur J Neurol. 2022 Jan;29(1):350-357. doi: 10.1111/ene.15103.
4. Rubin JB, Hameed B, Gottfried M, Lee WM, Sarkar M; Acute Liver Failure Study Group. Acetaminophen-induced Acute Liver Failure Is More Common and More Severe in Women. Clin Gastroenterol Hepatol. 2018 Jun;16(6):936-946. doi: 10.1016/j.cgh.2017.11.042.