This article explains what you should know about each medication before treating your headache.
Treatment of Tension-Type Headaches
Tension headaches are the most common type of headache. They are primary headaches, which means a medical condition doesn’t cause them. Instead, lack of sleep, stress, hunger, hangovers, or clenching your teeth may trigger them.
Typically, people with tension headaches self-treat with several at-home remedies, including:
Over-the-counter (OTC) medicationsSleepExerciseWaterCaffeine
You may want to talk to your healthcare provider if your headache doesn’t respond to at-home therapies or you experience other symptoms, such as visual changes from an aura (which suggests a migraine, not a tension headache).
Common OTC medications for tension-type headaches include:
Tylenol (acetaminophen) Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium (Aleve) or ibuprofen (Motrin, Advil)
Tylenol vs. Advil
Whether you reach for acetaminophen or ibuprofen, either will most likely work. However, research is conflicting, with some studies suggesting ibuprofen may be more effective and others saying there is no difference.
Ibuprofen works better: In an older study published in the Journal of Clinical Pharmacology, over 450 individuals with tension headache received either 400 milligrams (mg) ibuprofen, 1,000 mg of acetaminophen, or a placebo (an inactive “sugar pill”). Results showed both medications were more effective than placebo in alleviating headache, with ibuprofen the most effective. No difference: A review study in Pain found both acetaminophen (1,000 mg dose) and ibuprofen (400 mg dose) were better than placebo at alleviating moderate to severe tension headaches within two hours. Neither was found to be more effective than the other. The study also found that only about one in nine people who took either drug were pain-free two hours later. This means that there are still many people who are not getting proper pain relief.
Potential Adverse Effects
In addition to their effectiveness, it’s critical to consider the potential adverse effects of each medication.
Acetaminophen
Acetaminophen, while generally well tolerated, may cause liver failure in high doses. In addition, be aware that many OTC cold and flu medications contain acetaminophen. So, check the label of all the drugs you take to ensure you don’t exceed the maximum recommended daily limit.
Furthermore, in pregnancy, acetaminophen is generally the preferred choice for a tension headache. However, be sure to confirm with your healthcare provider or obstetrician.
NSAIDs
Some people with certain risk factors should avoid NSAIDs, like ibuprofen. That’s because NSAIDs may cause or worsen certain health conditions, including:
Peptic ulcer disease Gastric bleeding Kidney failure Worsening of underlying high blood pressure
Moreover, if you have risk factors for stroke or coronary artery disease, NSAIDs may increase your heart attack or stroke risk. Therefore NSAIDs should not be taken by those with certain health conditions, including:
History of stomach bleedingKidney diseaseHeart disease
In addition, people with a history of asthma should also be cautious about taking NSAIDs since they may trigger airway inflammation.
Which to Choose
Tylenol and NSAIDs are both reasonable first-choice options for relieving the pain of a tension headache.
NSAIDs are associated with peptic ulcers, kidney failure, and high blood pressure. Therefore, people with certain underlying health problems should avoid NSAIDs, including those with heart conditions, stomach bleeding, and kidney disease.
Typical dosages are as follows:
Ibuprofen: 200 mg to 400 mgTylenol: 325 mg or 650 mgAleve: 220 mg to 440 mg
Of course, it’s essential to always speak with your healthcare provider before taking medication, including OTC drugs, to make sure it is safe for you.
When Tylenol or Advil Fails
If you don’t get headache relief from a dose of Tylenol or an NSAID, you might want to consider a two-tablet dose of Excedrin Extra Strength. This medication contains a combination of drugs, including:
Acetaminophen (250 mg) Aspirin (250 mg) Caffeine (65 mg)
For some people, a combination of pain relievers and caffeine may work better for treating tension-type headaches than a single pain reliever. That said, combined products may cause more side effects, such as stomach upset or dizziness, although these are generally mild and short-lived.
However, remember that Excedrin contains both aspirin (an NSAID) and acetaminophen. So, be sure to stay within recommended daily limits, especially if you combine it with other types of medication.
Summary
Advil and Tylenol are common OTC treatments for headache relief. Research supports the use of either; however, if you have certain risk factors, you may want to choose one over the other. For example, Tylenol can be hard on the liver if taken too long or in high doses. If you have liver disease, you may want to avoid Tylenol.
On the other hand, NSAIDs, including Advil, carry a risk of peptic ulcers, kidney failure, and high blood pressure. So, if you have a history of stomach bleeding, kidney disease, or heart disease, you should steer clear of NSAIDs.
Alternately, Excedrin is a combination product that contains aspirin, acetaminophen, and caffeine. Some people with severe headaches find that this works best. However, as it combines several ingredients, be careful to stay within the recommended dosages.
A Word From Verywell
In the end, if you have tension headaches and want to take an over-the-counter medication, either ibuprofen or acetaminophen is a sensible choice. You may get more benefits from ibuprofen, but this is not a hard and fast rule. As always, speak with your healthcare provider before you take any medication.
