Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Tylenol (Acetaminophen) For Migraine Headaches: It May Be All You Need For Acute Pain
Posted in Migraine Headac... by Dr. Sharon Orrange on Mar 22, 2011
With so many newer migraine medicines in the triptan class (Imitrex, Maxalt, Amerge, Relpax, and Frova) and several good non-steroidal anti-inflammatory drugs (NSAIDS) like Naproxen and Ibuprofen, Acetaminophen (Tylenol) was taking a back seat for a while.

As a physician who treats many migraine sufferers, a recent large review of clinical trials surprised me. This Cochrane review looked at how effective and safe Acetaminophen was for acute migraine headaches in adults, and the results were pretty darn good for this old favorite.

In adults with acute migraine headaches, acetaminophen taken when pain is moderate or severe is more effective than placebo for reducing headache pain at 1 and 2 hours and eliminating pain at 2 hours. Acetaminophen did not differ from sumitriptan (Imitrex) for reducing headache pain at 2 hours and was associated with fewer side effects than sumitriptan.

At 2 hours, 56% of patients who took 1000 mg of acetaminophen had headache relief, and 18% were pain free at 2 hours with a single 1000mg dose of acetaminophen.

Acetaminophen is relatively free of side effects and does not cause gastrointestinal bleeding like NSAIDS or aspirin. It is metabolized in the liver (not the kidney) and is safe to take in doses up to 4 grams (4000 mg) a day. Because acetaminophen and sumitriptan (Imitrex) have similar results it may be reasonable to start with 1000 mg of acetaminophen at the start of a headache and add a triptan at 2 hours if you have no response.

Thoughts?

Dr O.



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Displaying comments 23-4 of 23
23
My first thought was, how dare you post, 'all you need for a migraine,?' That minimizes the agony of the pain and real illness pts with migraine suffer and makes it sound like a garden variety headache. It also negates the good news that something as readily available and inexpensive as Tylenol can be as effective as Imitrex. I'm also bothered by the fact that you make Tylenol sound innocuous, stating that it can dosed up to 4000mg/24 hours. Some pts might mistake that for meaning it's ok to take a little more and overdose and damage their liver - all because a physician said so on the internet.

Jeez. I'm not a physician, I'm not even in the medical field - I work in psych and suffer with migraines but know that pts will misinterpret the data and take it as fact. If you've ever played 'telephone,' you'll know exactly what I mean. This article while having valid points misleads the average person.
By ThePeople  Jun 29, 2011
22
You have got to be kidding and it's a very bad joke at that! I've had migraines for decades. Acetaminophen & NSAIDS don't even begin to touch the pain. Until the triptans came onto the market, I never had any relief at all. And at that, I'm fortunate. Many of the migraine sufferers I know are not helped by triptans either.

We have a hard enough time convincing family members, employers and teachers that we don't "just have a headache". You do us a serious disservice by promoting the mythology around migraines. Please find out what migraines are really about. Then remove your unfair, untrue article.
By crtfly  Jun 28, 2011
21
Are you serious? Tylenol. Tylenol doesn't even cut it for menstrual cramps let alone the MILDEST migraine. Yes it is a COMPONENT in other medications but to say it works alone against a migraine is preposterous. If it does, then someone doesn't know what a migraine is, i.e. it's a regular headache (and for me, it wouldn't even work with that!) Please learn how to interpret findings (as others have pointed out) before you post this drivel.
By HeelerLady  Jun 28, 2011
20
Note: the Cochrane Review summarizes across many studies. They do not report on what the studies were, who conducted them, or who sponsored those studies. Therefore that information is lost.

They also provide many other studies on the effectiveness of various triptan drugs which are not reported here. Just this one analysis which shows that Tylenol slightly out performed a placebo, but 82% of the people still were in pain 2 hours later. So sad....
By migrainestoomuch  Jun 27, 2011
19
Sadly this very biased post by Dr Orrange and her unwillingness to engage on the responses to it seriously undermine the integrity of this site.

Drug companies pay big bucks to have studies like that run. New ethics guidelines require doctors to disclose in their journal submissions if they received any funding from a drug company and if they received 'ghost articles' provided by others for publication ( a big problem these days).

If you will notice this site has a number of resident doctors who provide articles like her. I doubt they do this for free.

(1) Dr Orrange are you paid for your participation in this forum?
(2) Does this website make money from the advertisements of drug manufacturers?
(3) Is there any link between the "studies" or research promoted by the doctors here and the companies paying for this website?
By migrainestoomuch  Jun 27, 2011
18
Sadly this very biased post by Dr Orrange and her unwillingness to engage on the responses to it seriously undermine the integrity of this site.

Drug companies pay big bucks to have studies like that run. New ethics guidelines require doctors to disclose in their journal submissions if they received any funding from a drug company and if they received 'ghost articles' provided by others for publication ( a big problem these days).

If you will notice this site has a number of resident doctors who provide articles like her. I doubt they do this for free.

(1) Dr Orrange are you paid for your participation in this forum?
(2) Does this website make money from the advertisements of drug manufacturers?
(3) Is there any link between the "studies" or research promoted by the doctors here and the companies paying for this website?
By migrainestoomuch  Jun 27, 2011
17
I wish Tylenol would work then I could go off of my preventative Topomax, and function better. Would love to know who did the study.
By casual  Jun 26, 2011
16
You have really distorted that study. How about reporting what the study really says:

2 hours after taking 1000 mg of Acetaminophen, 82% of migraine suffers were still in pain. Imitrex was little better in providing them with pain relief.

Clearly the vast majority of migraine suffers need new research and additional medicinal approaches to improve their quality of life and reduce their need for disability. Far too many suffer from this debilitating condition (around 10% according to WHO), that is greatly misunderstood or trivialized.
By migrainestoomuch  Jun 25, 2011
15
Sorry some of my comments posted three times -- I had to split up my comments because they were too long.

Obviously posting the same thing 3 times is due to STRESS and I should file for disability immediately
By Abraxas  Jun 24, 2011
14
It is not something you can take and "be on your way about your business". A full-blown Migraine is going to put one in bed. How much agony you suffer there might be lessenned somewhat by this barbiturate-laced stuff, I am grateful for ANY pain relief that actually works and I thank my doctor for prescribing it. She admits that all the other conditions I have may have nothing to do with the migraines -- she says they may be caused by "stress" -- well now that pins it down doesn't it?

She told me to cut out sodas and I did -- but it is quite another matter to say "I will hereby eliminate STRESS from my life"

To hear it said that "well, we really don't know what causes migraines" is one thing, and I guess we just have to live with that until someone discovers different -- but to hear "just take Tylenol" - that's just adding insult to injury.
By Abraxas  Jun 24, 2011
13
If Exedrin Migraine DID THE TRICK FOR US, DO YOU THINK WE WOULD HAVE A suuport group for migraine sufferers? HARDLY.

Exedrin Migraine is a combination of Acetaminophen, Caffeine, and Aspirin. We read this on the label. My prescription med BUTALBITOL -- conatains acetaminophen, caffeine, and a barbiturate ingredient available only by prescription.
By Abraxas  Jun 24, 2011
12
If Exedrin Migraine DID THE TRICK FOR US, DO YOU THINK WE WOULD HAVE A suuport group for migraine sufferers? HARDLY.

Exedrin Migraine is a combination of Acetaminophen, Caffeine, and Aspirin. We read this on the label. My prescription med BUTALBITOL -- conatains acetaminophen, caffeine, and a barbiturate ingredient available only by prescription.
By Abraxas  Jun 24, 2011
11
If Exedrin Migraine DID THE TRICK FOR US, DO YOU THINK WE WOULD HAVE A suuport group for migraine sufferers? HARDLY.

Exedrin Migraine is a combination of Acetaminophen, Caffeine, and Aspirin. We read this on the label. My prescription med BUTALBITOL -- conatains acetaminophen, caffeine, and a barbiturate ingredient available only by prescription.
By Abraxas  Jun 24, 2011
10
Hey you guys
Tylenol (acetaminophen) has been included in excedrin migraine and other migraine medicines for years so this is not a new idea. Sometimes what works in some people surprises us, but the fact that tylenol works for some (apparently) does not trivialize migraines. Dr O.
By DrOrrange  Jun 24, 2011
9
Tylenol for Migraine??? Bwahahahahahahahahah!
By Abraxas  Jun 23, 2011
8
my thoughs, dr O:
tylenol for MIGRAINE???

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By Cluelesskitty  Jun 23, 2011
7
Frankly, I don't believe the people who had relief actually had a MIGRAINE. Any migraine sufferer will tell you that ordinary pain relievers don't help much.

My first, which would be actue, put me in hospital on IV meds. I could not keep anything down at all. I had tried tylenol at the very start believing that it was just a headache. I tried other things as the hours went on also.

The other issue is that tylenol has been proven to be seriously damaging to the liver in much smaller quantity that was once thougth so it needs to be used sparinly.
By SunnyBunn  Jun 23, 2011
6
Its easy for people with charts and graphs to try and say what works better for other people's pain, Id like to know how much TYLENOL is paying this doctor to plug their product. Tylenol is a great medicine BUT no one suffering with a migraine wants to wait an extra 2 hours to get relief from a pain that I can honestly say can be as bad as childbirth. Of course in their study tylenol would be more effective than nothing!This study is a joke, 18% of people had complete pain relief in 2 hours with tylenol so now it should be the method? Perhaphs those people had other environmental factors or didnt really have migraines. Would you base the treatment of other people on mere 18% of people participating in a study? Would you give a woman in labor tylenol just because a few other women said it worked for their pain? I think not.
By EmptyMirror  Jun 23, 2011
5
I don't think so! We are talking migraines here and 'clinical trials' are suggesting Tylenol for ACUTE migraines! Maybe minor ones, but certainly not acute ones. Do you honestly think we are a bunch of whiners that are too stupid to have not figured out that two tylenol could have fixed us up! Do you realize that people kill themselves over this disease! An article like this puts back the need for research and help into an area that already has a bad stigmatism and is in desperate need of serious attention.
By Enigma609  Jun 23, 2011
4
The only problem I have with tylenol is the way that it works. Forgive me if I am grossly oversimplifying but am I correct that all tylenol does is temporarily block the production of the hormones which tell your body that it is in pain or has fever for a period of time? If this is correct, would it not be accurate to say that it in fact does nothing to actually reduce your current pain level and leaves your body to find a way to reduce to level of those pain hormones on its own...it only keeps it from getting worse, so to speak? My question is, how is this helping?
By someonenew  Apr 03, 2011

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