Over-the-Counter Drugs for Acute Migraine Attacks: Literature Review and Recommendations

• Published in: Pharmacotherapy 2003-04, Vol.23 (4), p.494-505
• Main Authors: Wenzel, Richard G., Sarvis, Carrie A., Krause, Michelle L.
• Format: Article
• Language: English
• Subjects: Acute Disease; Analgesics, Non-Narcotic - therapeutic use; Animals; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Clinical Trials as Topic - statistics & numerical data; Drug Therapy, Combination; Humans; Medical sciences; Migraine Disorders - diagnosis; Migraine Disorders - drug therapy; Nonprescription Drugs - therapeutic use
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.23.4.494.32124

Migraines affect 28 million people in the United States, and most of these individuals experience attack‐related morbidity. Six of every 10 patients with migraine treat their headache exclusively with over‐the‐counter (OTC) products. Overreliance on OTC agents contributes to preventable morbidity and drug‐induced headaches. To evaluate the role of OTC drugs in the management of migraine headaches, we performed a qualitative systematic literature search by using MEDLINE (January 1966‐April 2002), analyzed the references of articles returned by the MEDLINE search, and reviewed other pertinent literature. In the studied populations, acetaminophen, aspirin, ibuprofen, and an aspirin‐acetaminophen‐caffeine combination product were shown to be more effective than placebo at reducing moderate or severe migraine pain to mild or no pain by 2 hours after administration. However, published trials of OTC agents have systematically excluded patients enduring morbidity with 50% or more of attacks and/or vomiting with 20% or more of attacks. Patients who experience disability during the predominance of their attacks are poor candidates for OTC‐exclusive therapy and should seek a physician's help for migraine‐specific prescription drugs. For those with migraine who encounter disability with less than 50% of attacks and/or vomiting with less than 20% of attacks, sole treatment with OTC products is a feasible option. Patients who fail to obtain acceptable relief after an adequate trial of OTC agents also should be referred to a physician. Pharmacists are well positioned to assess whether patients could benefit from OTC agents or should seek a physician's assistance.