What’s the Best Headache Medicine: Tylenol, Excedrin or Advil?

Pharmacists recommend Tylenol most often for headache relief. Here’s why.

Pharmacists recommend Tylenol most often for headache relief. Here’s why.
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If your medicine cabinet is stocked with any kind of drug, it's likely some type of over-the-counter headache relief product such as Advil, Aleve, Excedrin or Tylenol – or maybe all of the above. While each claims to relieve throbbing pain that prevents you from focusing at work or enjoying time with your kids, pharmacists say some brands may be better suited for getting you back to your desk or feeling ready to chase toddlers in the park.

U.S. News, in partnership with Pharmacy Times, a monthly trade journal for pharmacists, surveyed hundreds of pharmacists to see which over-the-counter headache medications they recommend most often. The results, listed in the Pharmacy Times OTC Guide and U.S. News' Top Recommended Health Products list, indicate three frontrunners in the headache relief market.

Pharmacists rated Tylenol No. 1 in the headache products category with 27 percent of the vote, followed by Excedrin with 24 percent and Advil with 23 percent.

Product Name Percent of Pharmacists' Votes
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Tylenol 27%
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Excedrin 24%
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Advil 23%
  Aleve 13%
  Motrin 13%

Zahid Bajwa, director of the Headache Institute at Boston PainCare Center and secretary of the American Academy of Pain Medicine, says it makes sense pharmacists recommend Tylenol most often since the drug has a "long record of safety." Tylenol has fewer harmful interactions with other medications, Bajwa says, and people have less risk of experiencing side effects compared to other headache relief products.

The Handbook of Nonprescription Drugs states that Tylenol "usually has no side effects." However, people with liver problems should be cautious when taking Tylenol, since its main ingredient is acetaminophen – also found in Excedrin – which can cause liver damage when consumed in large amounts. Meanwhile, over-the-counter headache products Advil and Motrin contain ibuprofen – an anti-inflammatory drug used to treat pain, fevers and swelling – which can cause stomach irritation, heartburn, dizziness, nausea and vomiting. Tylenol does not typically cause these side effects, according to Bajwa.

[Read: Top Recommended Pain and Inflammation Products.]

If you find yourself battling constant head pain, you're not alone. Read more about one of the most common forms of pain and health complaints in the United States:

How common are headaches? Seven in 10 people have at least one headache a year, and 45 million Americans suffer from chronic headaches, according to the American College of Physicians. The National Institute of Neurological Disorders and Stroke reports that two out of three children will have a headache by age 15, and about nine in 10 adults will experience a headache sometime in their life.

Episodic vs. chronic headaches. About three in four headaches are spurred by tension in the scalp and neck muscles, according to the American College of Physicians. Headaches caused by tension are classified as episodic or chronic. The National Headache Foundation characterizes both types as a "dull, aching and non-pulsating pain" that can impact both sides of the head. An episodic headache may be triggered by temporary stress, anxiety or fatigue, while a chronic headache is a continuous headache in which the intensity of pain may fluctuate during a 24-hour period.

[Read: Headache Relief: 6 Tricks to Relieve the Pain.]

Headache triggers. Headaches may be caused by many factors, including stress, anxiety, hormone fluctuations, changes in weather, noise and poor lighting conditions when reading. Staring at computer screens for prolonged periods of time may also play a role, since eye strain can lead to frontal headaches. When using a computer, health experts recommend looking away every 10 to 15 minutes and focusing on another object to avoid eye strain.

For some people, dehydration, skipping meals and certain foods may trigger a headache. The Cleveland Clinic lists aged cheeses with a high concentration of the natural product tyramine – found in blue cheese, cheddar and mozzarella — and processed foods with nitrates — including hot dogs, sausage and lunch meats – as potential headache triggers.

The clinic also names red wine, beer, whiskey, Scotch and champagne as the most common alcoholic triggers. Sulfates used as a preservative in alcoholic beverages may cause a headache; the higher the concentration of sulfates, the greater the chance a person may develop a migraine.

Does caffeine harm or help? Caffeine in coffee, soft drinks, tea and chocolate may produce headaches. The Cleveland Clinic says consuming more than 300 milligrams a day of caffeine may lead to a headache, but small amounts may actually improve a migraine. Excedrin – the top recommended migraine headache product – contains 40 to 65 milligrams of caffeine. As the Cleveland Clinic states, caffeine can increase the effect of ingredients in pain relieving drugs by 40 percent. On the other hand, caffeine is a diuretic and can cause dehydration, which Bajwa says does not help headaches and migraines. Bajwa recommends that patients with headaches should not consume more than a few hundred milligrams of caffeine per day. For reference, a small cup of tea has about 60 to 80 milligrams of caffeine, while a small cup of coffee contains about 150 milligrams.

[Read: Understanding Migraine Headaches.]

Overdosing on painkillers. About 25 percent of over-the-counter painkillers are used by buyers to treat headaches, according to Bajwa. Some patients overmedicate in an attempt to quickly rid their pain, but taking more than a recommended dose may not resolve a headache. In fact, it may only make matters worse, as the National Headache Foundation says three or more doses of painkillers per day for five days can sometimes lead to rebound headaches. An optimal dose varies for each person and depends on your age, medical history, allergies to medications and other health factors, so for best results, consult your doctor.

Treating your headache. To manage a basic headache, Bajwa notes that Tylenol is a safe option and can be taken every four to six hours. But it's important to check with a doctor or pharmacist before taking medication for headache relief if you are pregnant, have a pre-existing medical condition or are taking vitamins, supplements or other medications, which can have potential negative interactions with headache relief drugs. Cold and allergy medications also often contain pain relieving ingredients, so it's a good idea to read all drug labels to ensure you do not take multiple medications with pain relievers, which could lead to toxicity. Users should also avoid mixing alcohol with headache medications, and parents should consult a doctor before giving headache medication to children under age 10.

If you experience headaches, Bajwa advises to see a doctor and not rely on self-medication, since headaches can be an indicator of other health problems. "The chances of brain tumors and infections are small," he says, "but by only self-medicating, you may be turning your infrequent headaches into a more frequent problem."