WebMD Ask the Pharmacist

Headache and Migraine Treatment: Ask the Pharmacist

May 25, 2010. Pharmacist Heather Free, PharmD, answers questions about treatment for headaches and migraines.

Question:

What is the best way to treat persistent migraines?

Answer:

Persistent migraines need to be defined a bit more, by intensity, frequency, and the type of treatment you are using to elevate the pain. If you are using over-the-counter medications to treat your migraines more than 1-2 times per month, then you may want to seek medical advice from your health care professional.

Prescription medications that relieve the symptoms would be the next step. If symptomatic relief medications, such as ergotamines and triptans, are used more than twice a week, you should see your health care professional, who can prescribe preventive headache medications. Overuse of symptomatic medications can actually cause more frequent headaches or worsen headache symptoms. Monitor the frequency of your migraines. Understand the triggers to provide better information to your health care professional in order to help select the best treatment that is right for you.

Question:

I am taking lisinopril for high blood pressure. I started taking it at night because it makes me tired and weak when I take it during the day. Now I wake up with a headache. Is there a certain time I should take it?

Answer:

Common side effects for lisinopril are cough, diarrhea, dizziness, headache, and tiredness. Many of these side effects wear off about 2-3 weeks after starting the medication. I would see if the side effects wear off. If the side effects become too cumbersome, you may want to talk to the prescriber to see if you can be prescribed another blood pressure medication.

Question:

What will work better for migraine relief? Darvocet-N 100, Tylenol With Codeine No. 3, or Lortab?

Answer:

Pain associated with migraines is a very individualized symptom. It isn't a symptom that a health care professional can visually see to measure the intensity. We rely on the patient to give specifics on the tolerability and type of pain so we can better identify the type of medication that will work specifically for your type of pain and the location of the pain. Without knowing more about your pain, I would not be able to tell you which medication is better. I can inform you a bit more about the details of each medication.

One common ingredient in all three of these products is acetaminophen, which functions to increase the effects of the primary pain reliever. In addition to acetaminophen, Darvocet contains propoxephene. Tylenol No. 3 contains codeine. Lortab contains hydrocodone. These medications are the primary pain relievers. They also cause drowsiness.

While analgesics (acetaminophen), NSAIDs, and narcotics relieve pain, they don't address the underlying physiology of the migraine, which is primarily the dilation of blood vessels in the brain causing pressure on nerves in such a tight closure of an area. Two classes of migraine drugs that can aid with the dilation of blood vessels in the brain are ergotamines and triptans.

Question:

I have pain right below my right ear that radiates to my head, making me feel like I am getting a headache. What would cause this? Is this cause for alarm?

Answer:

I would seek medical attention to make sure that there isn't anything wrong and to treat the underlying condition.

Question:

I take zonisamide at night and Lyrica for migraine prevention. I also take Entocort EC for colitis, Maxalt for my migraines, and atenolol for high blood pressure. I was recently prescribed Celexa for hot flashes. Are there any known interactions between these drugs?

Answer:

Zonisamide, Lyrica, and Celexa have a similar side effect of increased dizziness and drowsiness. Combining all three of these medications can increase the intensity of their side effects. Driving and doing activities that require cognitive function may be more difficult than usual. The side effects may subside with time.

Maxalt is a triptan medication for symptomatic relief of the migraine. Celexa works on serotonin receptors, just as Maxalt can. The increased combination of both these products may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition. Symptoms of the serotonin syndrome may include mental status changes, such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction, such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms, such as abdominal cramping, nausea, vomiting, and diarrhea. Because of these side effects, I would monitor how frequently the migraines occur and how often you are taking the Maxalt. If you are taking the Maxalt more than twice a week then you may need to start taking a preventative medication.

Monitor all your side effects, if you have any, and make sure to partner with your pharmacist or health care professional regarding any concerns or discomfort.

Question:

Can my daughter take naproxen sodium if she has a grade 1 concussion? She is also on her period and experiencing cramps. She suffered the concussion three days ago.

Answer:

Headaches can be a common side effect from the trauma of the concussion, and NSAIDs (non-steroidal anti-inflammatory drugs) are commonly used to help treat the pain.

Question:

To help get rid of a migraine, can I mix Excedrin and Goody's Powder? I am also on phentermine.

Answer:

First, let's take a look at all the products and their ingredients. There are several different product selections for both Goody's and Excedrin. It is important to read the back of the box/label to compare the active ingredients. Excedrin Migraine contains acetaminophen 250 mg, caffeine 65 mg, and aspirin 250 mg. Goody's Powder Extra-Strength contains acetaminophen 260 mg, caffeine 32.5 mg, and aspirin 520 mg. In these two products alone, we see duplication of ingredients, which increases the risk of toxicity and additive side effects.

Two tablets of Excedrin Migraine can contain as much caffeine as a cup of coffee. It is recommended that you limit the use of caffeine-containing medications, foods, or beverages while taking this product. Too much caffeine may cause nervousness, irritability, sleeplessness, and occasionally, rapid heartbeat.

It is important to continue to check with your pharmacist or health care professional to make sure there continues to be no known drug interactions between these ingredients.

Question:

How long after the expiration date can you use Advil and still experience some relief by taking it? Would it hurt me if I took Advil that has expired?

Answer:

Expiration dates on products, whether it is medication or food, are printed on the package for a reason. It is to protect you from damaging your body (making you ill), and to let you know that the product will no longer be effective. We wouldn't drink milk that is 2 weeks past its expiration, so why would you want to take Advil 2 weeks past the expiration? Advil is used to treat pain, fever, and inflammation. You would not want to extend your symptoms due to taking an expired ineffective product. Nor would you want to guess at how many tablets you have to take to get an effective dose, increasing the possibility of toxicity and side effects.

This is not a gray situation. It is black and white. Either the medication is safe to take or not. If the medication has expired, please do not ingest it. Instead, work with your pharmacy or local police department on how to dispose of expired medication.

Question:

Can you give a 9-year-old Excedrin Migraine medicine?

Answer:

Excedrin Migraine contains acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg. Aspirin and products containing aspirin should not be used for children due to the increased risk of Reye's syndrome. The exact cause or cure for Reye's syndrome is unknown. However, we do know that children taking aspirin increases the risk, which attacks the organs of the body. Since there isn't a cure, we don't want to take the risk of harming the child.

I would not give your child Excedrin Migraine. Pay attention to the label on all over-the-counter medication to make sure you taking appropriately, and so you know the recommended age as well.

Question:

Can I take Maxalt MLT with Tylenol?

Answer:

There currently are no drug interactions reported between Maxalt MLT and Tylenol. It is important to consult with your pharmacist or health care professional to make sure these medications remain safe to take together.

Question:

Can I give my 11-year-old son ibuprofen liquid gel? He is 70 pounds.

Answer:

At his weight he can take 300 mg by mouth every 6 hours with food. This is equivalent to 3 tsp (15 mL) of liquid, 6 tablets of the 50 mg chewable tablets, or 3 tablets of the 100 mg caps or chew. It is important to read the label on the box to see how much one dose is equal to in milligrams and then calculate from there. Hope this helps!

Question:

I am taking sulfameth/trimethoprim for a bladder infection. Tonight I have a terrible headache. Can I take acetaminophen? (Excedrin Migraine)

Answer:

You can take either product; acetaminophen or Excedrin Migraine. Only take one since Excedrin Migraine contains acetaminophen as one of the three active ingredients (along with caffeine and aspirin). Make sure to follow the instructions on the bottle closely to make sure you are taking appropriately and for the correct reasons.

Question:

What is the strongest over-the-counter headache/pain reliever medicine?

Answer:

There is no stronger over-the-counter medication for headache or migraine pain relief. Headaches are very individualized. There are several over-the-counter medications you can use to alleviate painful headaches. These medications include acetaminophen (Tylenol), an effective over-the-counter analgesic (pain reliever) and antipyretic (fever reducer) medication. This medication can help with achy pain, stiffness, and fever. However, it does not have any anti-inflammatory properties. This is important for some types of headache relief. In addition, the nonsteroidal anti-inflammatory drug class (NSAIDs) consists of products like ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve), which work by exhibiting analgesic relief, antipyretic, and anti-inflammatory properties. Lastly, combination products, such as Excedrin Migraine, contain acetaminophen, aspirin, and caffeine. These ingredients combined make a more powerful headache/pain reliever than the ingredients separated out alone.

It is important to follow the instructions on the label of over the counter medication and not to mix products, in order to prevent overdosing or toxicity. Monitor the frequency and intensity of your migraines to know when it is time to seek professional help and possibly the addition of a prescription medication.

Question:

How much Tylenol can a 9-week pregnant woman take?

Answer:

A pregnant woman can take up to 4 grams of acetaminophen daily, as per the regular adult dose for this mediation. It has been used and proven safe to take during pregnancy.

Question:

My 16-year-old daughter takes topiramate 25 mg for prevention of migraines. She takes half a tablet, twice each day. She has also been prescribed omeprazole 20 mg, 2 caps (at the same time) once daily. What is the interaction of these two meds and can they be taken at the same time or should they be taken separately?

Answer:

There currently are no reports of these two medications interacting with each other. Consult your pharmacist to make sure there are no new updates concerning the administration of these two medications together. You should be fine to take them at the same time, without any issues.

Question:

Can I mix Vicodin with Fioricet?

Answer:

Let's look at the ingredients of each of these medications separately. Vicoden contains hydrocodone and acetaminophen. Fioricet contains acetaminophen, butalbital, and caffeine. I would be cautious in using both products, in order to prevent overdosing of acetaminophen. This medication, while safe as an over-the-counter medication, can cause damage to the liver at extreme doses. If you need to take both medications, consult your local pharmacist to discuss the correct dose for you.

Question:

I recently contracted food poisoning and was subsequently prescribed ondansetron 4 mg to help with nausea. I also have terrible body aches. I was wondering if it is safe to take Advil or Tylenol while on this medication.

Answer:

There currently are no reports of these two medications interacting together. Consult your pharmacist to make sure there are no new updates concerning the administration of these two medications together. You should be fine to take them at the same time, without any issues.

Question:

What is in the drug Toradol? I have taken it twice for migraines and it works wonderfully.

Answer:

Toradol is a nonsteroidal anti-inflammatory medication (NSAID) that is prescription-strength. It helps to reduce inflammation, swelling, and pain that can all be associated with the migraines.

Question:

Can I take meloxicam, Tylenol, and Aleve at the same time?

Answer:

Meloxicam is a prescription strength nonsteroidal anti-inflammatory drug (NSAID), while acetaminophen (Tylenol) is an effective analgesic (pain reliever) and antipyretic (fever reducer). Aleve is an over-the-counter NSAID. I would not take Aleve while taking meloxicam, due to the increased risk of side effects and toxicity issues. If you need to take a pain reliever in addition to the meloxicam, I would stick with the acetaminophen. If this doesn’t alleviate the migraine/headaches, then I would consult your health care professional about the cause of the migraines and what can be used to treat the symptoms.

Question:

I went to the doctor with severe headaches due to allergies. My right ear is impacted. I have used an earwax removal medicine with little to no relief. While at the office, I was given a sample pack of Maxalt for the migraines. Is there anything over-the-counter that is as effective?

Answer:

I would seek additional medical advice. If you are experiencing severe headaches associated with allergies, we should be treating the primary symptoms of the allergies. Nasal congestion and pressure in the head are treated with different medications than migraines. Any allergy specialist will agree that migraines are not caused by allergies.

Question:

Is the drug tramadol a controlled substance?

Answer:

This medication is scheduled as a legend medication, meaning that this is not a high-enough risk of addictive properties to be scheduled a higher controlled medication. It still requires a prescription.

Question:

I suffer from migraines and take a lot of medication for them. I am concerned I take too much and that it may be hurting my health. Is it safe to take Inderal, Topamax, Imitrex, hydrocodone, Limbitrol, and Yaz birth control?

Answer:

It is not uncommon to take birth control to help regulate hormone cycles, preventative medications to prevent the onset of a migraine (Topamax, Inderal, Limbitrol), and symptomatic relief medications (Imitrex) all together. Hydrocodone basically covers up the pain. To take three preventative medications along with everything else you listed does seem like a bit much. I would look at lifestyle modifications that you could possibly make in order to aid in the decrease of migraine frequency.

I would also seek another medical opinion from a migraine specialist or neurologist to see if all these medications are necessary. Keep in mind that a few of these medications have side effects of headaches, which could be a trigger to worsen or cause your migraines.

Question:

I take amitriptyline (for headache) and now the doctor gave me Ambien (for sleep). Can I take the two together?

Answer:

There is a moderate drug interaction between these two medications. The disabling of the motor coordination and mental alertness is effected with one medication alone. Both medications give an additive effect, or intensify the side effects. Depending on the dose doctors worry about respiratory depression. However, if the medications are taken according to the physician's directions there shouldn't be any issues. Just be cautious of the cognitive capabilities while on both these medications.

Question:

If I took Sudafed for what I thought was a sinus headache, can I take Tylenol, too?

Answer:

Yes, you can take both these medications together. Pseudoephedrine (Sudafed) and acetaminophen (Tylenol) are sometimes combined in some over-the-counter cold products. Make sure to following the instructions on the label and not to take more than needed. Make sure your pseudoephedrine product does not contain any other active ingredients to prevent double dosing with acetaminophen.

Question:

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

Answer:

I would be careful taking Maxalt daily on a regular basis. This medication is not designed or recommended for daily use. It is to be taken within the first hour of migraine symptoms. It doesn't prevent the onset, but rather helps to relieve symptoms from the migraine. I would seek a second medical opinion about using Maxalt daily.

Question:

Can I take ibuprofen for a headache if I am already taking Adderall XR 20 mg?

Answer:

There have not been any reports of drug interactions between ibuprofen and Adderall. Continue to consult your pharmacist to make sure there are not new updates concerning the administration of both these medications together.

Question:

Is it OK to take over-the-counter sleep aids such as Tylenol PM, Motrin PM, and Advil PM for migraines? Do some of these medications contain acetaminophen? Can these medications cause long-term side effects?

Answer:

There medications are intended to aid in sleeping. Tylenol PM (acetaminophen and diphenhydramine), Motrin PM (ibuprofen and diphenhydramine), and Advil PM (ibuprofen and diphenhydramine) all have medications to help alleviate the pain. The diphenydramine can help in making you sleepy. I would be cautious in using this product on a regular basis and would consult with your health care professional if migraines or headaches become persistent. Make sure to read the directions on the label carefully to prevent improper use of these over-the-counter medications.

Question:

Is Laudanum still used for headaches or anything else?

Answer:

Laudanum is an opium-type product still available, but not for the use of migraine relief. I suggesting consulting your health care professional if migraines or headaches are an issue and you are seeking treatment.

Question:

I take Midrin for headaches, but I am currently on Adipex P. Are these safe to take together?

Answer:

There have not been any reports of drug interactions between Adipex P and Midrin. Continue to consult your pharmacist to make sure there are not new updates concerning the administration of both these medications together.

Question:

Are there any natural remedies, such as acupressure or essential oils, to treat headaches?

Answer:

Many people have tried using herbals. Several herbal medications have been associated with aiding in pain relief, such as black willow, meadowsweet, passionflower, and valerian. It is very important to remember that herbals are not monitored for safety and effectiveness by the FDA. Therefore, we do not know how they work, or if they work. The side effects could be more intense than the benefit of taking the product. Research is limited when it comes to herbs.

However, we have seen many studies done using acupuncture and massage therapy with migraine patients. This is thought to relax the body to aid in the decrease of muscle tension and stress levels, and prevent the onset of migraines. Check with your insurance company, because sometimes these migraine-reducing therapies are insured services.

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