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A Comprehensive Review of Over-the-counter Treatment for Chronic Migraine Headaches

  • Other Pain (AD Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Migraine headaches are a neurologic disorder characterized by attacks of moderate to severe throbbing headache that are typically unilateral, exacerbated by physical activity, and associated with phonophobia, photophobia, nausea, and vomiting. In the USA, the overall age-adjusted prevalence of migraine in female and male adults is 22.3% and 10.8%, respectively.

Recent Findings

Migraine is a disabling disease that ranks as the 8th most burdensome disease in the world and the 4th most in women. The overarching hypothesis of migraine pathophysiology describes migraine as a disorder of the pain modulating system, caused by disruptions of the normal neural networks of the head. The activation of these vascular networks results in meningeal vasodilation and inflammation, which is perceived as head pain. The primary goals of acute migraine therapy are to reduce attack duration and severity. Current evidence-based therapies for acute migraine attacks include acetaminophen, four nonsteroidal anti-inflammatory drugs (NSAIDs), seven triptans, NSAID–triptan combinations, dihydroergotamine, non-opioid combination analgesics, and several anti-emetics.

Summary

Over-the-counter medications are an important component of migraine therapy and are considered a first-line therapy for most migraineurs. These medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks. The lower cost of over-the-counter medications compared with prescription medications also makes them a preferred therapy for some patients. In addition to their efficacy and lower cost, over-the-counter medications generally have fewer and less severe adverse effects, have more favorable routes of administration (oral vs. subcutaneous injection), and reduced abuse potential. The purpose of this review is to provide a comprehensive evidence-based update of over-the-counter pharmacologic options for chronic migraines.

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Authors and Affiliations

  1. Department of Anesthesiology, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, 33140, USA

    Jacquelin Peck

  2. Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Ivan Urits

  3. University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Justin Zeien, Shelby Hoebee, Mohammad Mousa & Hamed Alattar

  4. Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA

    Alan D. Kaye

  5. Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Omar Viswanath

  6. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Omar Viswanath

  7. Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ, USA

    Omar Viswanath

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Jacquelin Peck, Ivan Urits, Justin Zeien, Shelby Hoebee, Mohammad Mousa, Hamed Alattar, and Omar Viswanath declare no conflict of interest. Alan Kaye is a section editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript. Dr. Kaye is also a speaker for Merck.

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Peck, J., Urits, I., Zeien, J. et al. A Comprehensive Review of Over-the-counter Treatment for Chronic Migraine Headaches. Curr Pain Headache Rep 24, 19 (2020). https://doi.org/10.1007/s11916-020-00852-0

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