WebMD Ask the Pharmacist

Headache Medications: Ask the Pharmacist

Pharmacist Macary Marciniak, PharmD, BCPS, answers your additional questions about headache medications.

Question:

Can someone with high blood pressure take Excedrin Migraine?

Answer:

Excedrin Migraine is a nonprescription medication that contains acetaminophen, aspirin, and caffeine. Each Excedrin Migraine tablet contains 65 mg of caffeine. The label will direct you to take 2 tablets at one time, which is about the same as drinking 1 to 1 1/2 cups of coffee. Typically, people with high blood pressure should limit the amount of caffeine consumed on a daily basis. Someone with high blood pressure can take Excedrin Migraine safely, but I would also caution that person to watch how much additional caffeine he consumes through coffee or soda. Also, I would want to talk to the person about their migraines and see if there might be another option that could work just as well and be safer for him to take.

Question:

Can you take Aleve and Excedrin together? If not, what can you take with Aleve for a migraine?

Answer:

Excedrin is a nonprescription medication that contains acetaminophen, aspirin, and caffeine. Aleve is a nonprescription nonsteroidal anti-inflammatory drug (NSAID) and its active ingredient is naproxen. The aspirin in Excedrin and the Aleve (naproxen) are similar medications and are used for similar things. Aleve itself can be used for a migraine. And Excedrin can be used as well.

If you are taking the Aleve chronically (all the time) for something other than migraine (like pain), and you have tried the Aleve for the migraine, and it hasn’t helped, then go ahead and try the Excedrin. You can take both together for a short period of time. The biggest side effect you might notice is increased bleeding or bruising.

Question:

What kind of medicine can I take for a headache? I am 8 weeks pregnant.

Answer:

The pain reliever of choice for pregnant women is acetaminophen (brand name: Tylenol). Acetaminophen can be used safely during all trimesters of pregnancy. It is not recommended to use ibuprofen (brand name: Advil or Motrin) or naproxen (brand name: Aleve).

Question:

My doctor gave me butalbital APAP for tension headaches. I’m worried it’s a barbiturate. Is it?

Answer:

Butalbital/acetaminophen (APAP) is a prescription medication (generic) for headaches. Butalbital is a barbiturate. Barbiturates are medications that may be physically and/or psychologically addictive, so they should be used with caution. However, this medication is safe if used appropriately. If you have concerns, please talk with your health care provider or pharmacist.

Question:

Any info on the 2010 Midrin shortage? Is it available again?

Answer:

Midrin is a prescription medication that was used by many for the treatment of migraines. Unfortunately, it is my understanding that Midrin (and its generic equivalents) is no longer being manufactured. Honestly, it is a confusing story, but it did start with a manufacturer backorder, and there was times when generics were available. Midrin is an older medication and it was actually never approved by the Food and Drug Administration (FDA), but instead, was “grandfathered” into use. Manufacturers have decided to stop producing Midrin; it was not removed from the market by the FDA.

If Midrin was a product that you were using, talk with your health care provider or pharmacist about other options for migraines. There are a number of prescription and nonprescription options that can be appropriate for you.

Question:

Can I take Effexor and Imitrex? I was recently prescribed Effexor, and noticed on the information sheet it cautions against the combo.

Answer:

Effexor and Imitrex both have effects on the hormone serotonin, and taking them together could cause a rare problem called serotonin syndrome. Signs of serotonin syndrome might be agitation, sweating, diarrhea, fever, or tremors. This syndrome is serious, but does not occur often.

Imitrex is a medication that is only taken sporadically for treatment of migraines, while Effexor is a medication that is typically taken chronically (every day). Taking Effexor and Imitrex together is OK, particularly as one of these medications will not be used as often. Please notify your health care provider if you notice any of the signs of serotonin syndrome noted above.

Question:

Is there any over-the-counter medicine for severe headaches besides Excedrin Migraine that makes you jittery?

Answer:

Excedrin Migraine is a nonprescription medication that contains acetaminophen, aspirin, and caffeine. Each Excedrin Migraine tablet contains 65 mg of caffeine. The label will direct you to take 2 tablets at one time, which is about the same as drinking 1 to 1 1/2 cups of coffee.

Anacin is another nonprescription pain reliever that contains caffeine (32 mg), as well as aspirin. The label suggests 2 tablets of Anacin as well, which would be like drinking a little less than 1 cup of coffee.

Question:

What are the side effects of mixing Vyvanse and Excedrin Migraine?

Answer:

Vyvanse is a prescription medication used to treat attention deficit disorder. Taking both Vyvanse and Excedrin Migraine together may cause an increase in heart rate or blood pressure. You may be able to take both products together without too much difficulty, but if the side effects become bothersome for you, you may be able to try other medications for migraines that would not have the same interaction with Vyvanse.

Question:

My doc gave me Darvon-N 100 mg for my headaches. What is this exactly?

Answer:

Darvon-N is a prescription pain reliever that contains propoxyphene and acetaminophen. Darvon was actually withdrawn from the market in late 2010. This was based on data showing an increase in serious and fatal irregular heart rhythms. You should not continue to use this product. Please talk with your health care provider to discuss alternative medications to help treat your headaches.

Question:

How many Excedrins are safe to take in one day?

Answer:

Excedrin is a nonprescription medication that contains acetaminophen, aspirin, and caffeine. There are a number of different formulations available, including Excedrin Maximum Strength, Excedrin Migraine, Excedrin Tension Headache, Excedrin Menstrual Complete, and Excedrin PM. Per the product label, the maximum number of tablets that should be taken in one day varies for each product. Please consult your package label for the maximum amount that can be taken each day.

Question:

Is it OK to take over-the-counter sleep aids? I heard that some of these medications contain acetaminophen? Can these medications cause long term side effects?

Answer:

Over-the-counter sleep aids are safe to be used for a short period of time, preferably no longer than a week or two. There are sleep aids that contain acetaminophen (for example: Tylenol PM). It is very important to carefully read the label of all nonprescription medications you are taking.

In this example, if you were taking Tylenol PM, and also taking acetaminophen for headaches, then you may accidentally take too much acetaminophen in one day, which can increase the risk for long-term side effects such as liver problems.

Question:

Do Nexium and aspirin contradict each other? Since I begin taking Nexium, I notice that when I take aspirin I get blotches, charley horses, or red spots in my arms and hands. I have never had problem taking aspirin before.

Answer:

Nexium and aspirin do not interact with each other. Taking aspirin may cause bleeding or bruising, but charley horses are not be a common side effect. It would help to know more about why you are using the aspirin and how much you are taking.

If the aspirin is being used for general heart health, I typically recommend the 81 mg strength, rather than the 325 mg strength. The 81 mg strength is just as effective, but has fewer side effects than the 325 mg strength. Aspirin can interact with other medications, so it would also be important to consider any other medical conditions you might have, or other medications you might be taking.

If you are concerned with these side effects, please talk further with your health care provider who can determine if these problems may be linked with anything else.

Question:

My 16-year-old daughter takes topiramate 25 mg for prevention of migraines. She takes 1/2 tablet twice daily. She has also been prescribed omeprazole 20 mg, 2 caps (at the same time) once daily. Is there any interaction, and can they be taken at the same time?

Answer:

It is safe to take both topiramate and omeprazole at the same time -- there are no interactions. It is best to take the omeprazole 1 hour before the largest meal of the day (for most people, dinner). If your daughter would like to take her topiramate dose at the same time, that would be fine.

Question:

If I took pseudoephedrine for what I thought was a sinus headache, can I take acetaminophen, too?

Answer:

Yes, it is fine to take both acetaminophen and pseudoephedrine together, in fact, that may be very helpful for a sinus headache. Hope you feel better soon!

Question:

I am going to have a colonoscopy. I was told to quit taking any blood thinning drugs such as aspirin, etc. Are there any over-the-counter painkillers I can take for headaches?

Answer:

Acetaminophen (brand name: Tylenol) would be the medication of choice for your headache while awaiting your procedure. Acetaminophen does not have the risk of bleeding associated with other pain relievers like aspirin (brand name: Bayer), ibuprofen (brand name: Advil or Motrin), or naproxen (brand name: Aleve).

Question:

I was recently prescribed Topamax to try to prevent my headaches. Can numbness of my toes occur as a side effect, or should I be more concerned and see a physician?

Answer:

A feeling of “pins and needles” or your “foot falling asleep” can be a side effect of Topamax. Tingling or numbness sensations are more common side effects associated with Topamax. However, numbness in the toes may be associated with other conditions, such as nerve damage from having diabetes for many years.

To determine whether this is a side effect of the medication or something else, we would have to consider your other medical conditions, medications, and the timeframe when Topamax was started and the tingling started. Assuming that these symptoms were noticed only after starting the medication, and there are no other medical conditions that may be associated with nerve damage, it is likely that this is a side effect. If you have any concerns or would like your symptoms evaluated further, please talk with your health care provider.

Question:

I have been taking Excedrin for headaches. Doctor gave me Maxalt yesterday to take once daily. Took one this morning at 8 a.m. but head still hurts. Can I take an Excedrin now? It’s 5:30 p.m.

Answer:

Yes, it is fine to take both Maxalt and Excedrin together. It is important to note, though, that you can take another dose of Maxalt 2 hours after the first dose, if significant relief is not obtained from the first dose. Also, Maxalt comes in both 5 mg and 10 mg strengths. So, if you are taking the 5 mg strength and aren’t finding adequate relief, talk to your health care provider about obtaining a new prescription for the 10 mg strength.

Please don’t leave yourself in pain. Take another dose so that you may completely relieve your migraine!

Question:

Is Fioricet safe to take in early pregnancy?

Answer:

Fioricet is a prescription pain reliever that contains butalbital, acetaminophen, and caffeine. It is a medication that should not be taken during pregnancy. Once a woman finds out she is expecting, it would be best to discontinue use of this product.

If the woman was taking Fioricet before she realized she was pregnant, I would direct her to talk with her ob-gyn. An ob-gyn might be able to provide further guidance based on any concerns based on how long the medication was taken and how far along the pregnancy is.

Question:

My insurance company just raised the co-pay on Cymbalta, so I'm wondering, is there is a generic form?

Answer:

Cymbalta (duloxetine) is only available by prescription. It is relatively new to the market and a generic medication is not available yet. If the cost of the Cymbalta is now a concern for you, talk with your local pharmacist or health care provider.

Question:

Can I take ibuprofen when I get a headache if I am on Adderall XR 20 mg?

Answer:

There are no interactions with ibuprofen and Adderall XR, so they are safe to take together.

Question:

Is there aspirin in gabapentin or Lyrica?

Answer:

No, while both gabapentin and Lyrica can be used for pain (like aspirin), there is no aspirin in either gabapentin or Lyrica (pregabalin). 

Question:

I'm taking sumatriptan 50 mg tabs for migraine, and have been for some time. They work well for me. Is there a chance in the future they might stop working?

Answer:

Sumatriptan (brand name: Imitrex) is a commonly used prescription medication for migraine and it works very well. It does not appear that patients become tolerant to the medication and that it stops working for them.

It is possible, though, that migraines may increase in intensity as time goes on and perhaps another medication or dose of sumatriptan might be appropriate. If that is the case for you, talk with your health care provider to see if a change to your medication regimen might be appropriate at this time.

Question:

I take Maxalt for migraines. Can I take one for a current headache if I am having surgery in 8 days?

Answer:

Maxalt is safe to take and is not a medication that is typically stopped prior to surgery. If your provider asked you to discontinue this medication before surgery, you would be fine to take it now, as it will be completely out of system within a day.

Question:

I take propranolol ER 80 mg capsules for migraine prevention. Can I take Cialis at the same time?

Answer:

It will be OK to take both propranolol ER and Cialis at the same time. While propranolol can be used for migraines, it can also lower blood pressure. It is possible that taking both medications together could lower your blood pressure a bit. Just be cautious when first taking the Cialis to see how it affects you.

Question:

Is it safe to take prescription ibuprofen three to four hours after having an alcoholic beverage?

Answer:

Yes, it is safe to take ibuprofen after having an alcoholic beverage. It might be best to take the ibuprofen with food, to prevent stomach upset.

Alcohol can irritate the stomach, as can ibuprofen, so taking both together might just add to the effect. As I said, a little bit of food or a snack should help.

Question:

Topamax and Lexapro taken together, is it safe?

Answer:

Yes, Topamax and Lexapro can be taken together. Both have the tendency to cause some dizziness or drowsiness, so taking both together can often intensify the effect. You can still take them together, but I would be cautious when driving.

Question:

I am currently taking 5 mg oxycodone and 800 mg ibuprofen following a recent surgery. Can acetaminophen be taken along with this medication to relieve a persistent headache?

Answer:

Oxycodone is a very potent prescription pain reliever. If you are taking both oxycodone and ibuprofen currently, they should help to relieve your headache. You can take acetaminophen as well -- there are no interactions with the oxycodone and the ibuprofen. However, acetaminophen is not as strong as the oxycodone. So if the oxycodone is not sufficient for the headache, I am not sure that acetaminophen will help much more.

If this headache has been pretty severe and lasted for a few days, you may want to talk with your health care provider. You may be experiencing something more than just a simple headache, like a migraine, and may need to be evaluated to find the right medication for you.

Question:

Can a 62-year-old male taking Coumadin, Tenormin, and Micronase be able to take Anacin for his headache?

Answer:

Anacin is a nonprescription pain reliever that contains aspirin and caffeine. People who are taking Coumadin should not take aspirin-containing products (unless directed by their health care provider). There is a risk of increased bruising and bleeding.

For a headache, it is preferred that someone taking Coumadin take acetaminophen (brand name: Tylenol) instead. It is so important to check for interactions with prescription and nonprescription medications so thanks for your question!

Question:

I have been taking Levitra for ED. One of the side effects is headaches and some flushing of the face. I have read that this is a common side effect. Can I take an over-the-counter pain reliever at the same time?

Answer:

It is completely safe to take an over-the-counter pain reliever like acetaminophen (brand name: Tylenol), ibuprofen (brand name: Advil or Motrin), or naproxen (brand name: Aleve) while taking Levitra. It is also important to check to be sure the pain reliever you would like to use is safe with the other medical conditions you have, or medications you are taking. Assuming there are no other medical conditions or medications, then any of these pain relievers will be fine to take. Thanks for checking!

Question:

I was on citalopram for 10 years and abruptly went off and have been experiencing migraine-like headaches and tingling in my lips. Could these be withdrawal symptoms?

Answer:

Citalopram is part of a class of medications known as selective serotonin reuptake inhibitors (SSRIs). These medications should not be stopped abruptly, particularly in patients who have been using them for quite some time. Headaches could be a withdrawal symptom. Patients have also noted that they felt like they had “shocks” in their body, which you might perceive as lip tingling.

It is preferred that patients stopping this medication slowly taper down their dose over time. You should talk with your health care provider about a discontinuation strategy so that you will not experience these symptoms.

Question:

I've heard that you should take different types of headache medicines, depending on where your pain is in your head. Is that true? Can pain medications target different types of headache or different places?

Answer:

It is true that different types of headache medicines work differently or may be used for different types of pain. However, you don't need to select a medicine based on where your pain is.

If you need a recommendation for a particular type of headache, don't hesitate to ask your pharmacist. We are always available to help you sort out the medications and find the right choice for what is ailing you!

Question:

I'm allergic to aspirin. What can I take for my migraines?

Answer:

There are a number of prescription and nonprescription medications for migraine. Products available over-the-counter like Excedrin are not a good choice for you, as they contain aspirin. Some people who have allergic reactions to aspirin may also have an allergy to non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (brand name: Advil or Motrin) or naproxen (brand name: Aleve).

Talk with your health care provider to see if he/she wants you to avoid NSAIDs as well. If so, there are prescription medications for migraines called the “triptans” such as sumatriptan (brand name: Imitrex), zolmitriptan (brand name: Zomig), or rizatriptan (brand name: Maxalt). They work very well at relieving a migraine when it occurs, and they should be taken at the first sign of migraine symptoms. You will need to consult with a health care provider to obtain a prescription for one of these products, but these should be safe to take if you have an aspirin allergy.

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