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.