100 Migraine drugs, A to Z: Acetaminophen

Many migraine sufferers do not find acetaminophen (Tylenol) to be strong enough to treat migraine headaches and it does not have an official FDA approval for migraines (ibuprofen does). However, it is one of the most popular drugs for all kinds of pain, including migraines. And, in fact, double-blind placebo controlled trials have proven that acetaminophen does relieve pain and associated symptoms of migraine headaches.

One such study published in 2000 in the Archives of Internal Medicine by Dr. R. Lipton and his colleagues compared 1,000 mg of acetaminophen with placebo in 351 migraine sufferers. After 2 hours, 58% in the acetaminophen group and 39% in the placebo group reported relief. Twice as many had no pain at all after 2 hours in the acetaminophen group compared to placebo – 22% vs 11%. No side effects were reported in either group.

This study does not prove that acetaminophen is as strong as prescription drugs, such as sumatriptan (Imitrex), because the authors excluded patients with very severe attacks – those who needed to lie down and those who had vomiting more than 20% of the time.

So, while acetaminophen can help some patients with milder migraines, it can be a useful adjunct to a prescription drug, such as sumatriptan, especially if ibuprofen, naproxen, and other NSAIDs are contraindicated or cause upset stomach or other side effects. Acetaminophen is better tolerated than NSAIDs, but it should not be used at a high dose for long periods of time because it can cause liver damage.