Home' Trinidad and Tobago Guardian : May 10th 2014 Contents A36
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Guardian www.guardian.co.tt Saturday, May 10, 2014
Over-the-counter (OTC) medications ibuprofen
and Excedrin both relieve the pain and symptoms
of severe migraines better than placebo, according
to a new study.
Researchers reanalysed data from a clinical trial
and found that more than half of the people taking
either of the non-prescription drugs reported some
relief, though Excedrin containing caffeine performed
"This is not at all surprising," said lead author
Dr Jerome Goldstein. "Combination analgesics (like
Excedrin) have been around for a long, long time
and have had a big impact on treating migraine,"
he told Reuters Health. Goldstein is director of the
San Francisco Clinical Research Center and was
paid by Novartis for his work on the trial. His two
coauthors, Martin Hagen and Morris Gold, are
employed by Novartis Consumer Health, which
That medication, a combination of acetamino-
phen, aspirin and caffeine, is currently recommended
only for mild or moderate headaches, as is ibuprofen.
Migraine medications like Imitrex, for severe
migraine, are only available by prescription in the
US.For the analysis, the researchers only looked at
data from the 660 severe migraine sufferers in a
previous study, most of whom were female and
The migraineurs had been randomly assigned to
three groups, two of which received doses of Excedrin
or ibuprofen as well as placebo tablets marked to
look like one of the medications. Members of the
third group received only four placebo tablets.
In a diary, participants rated their pain level, nau-
sea, vomiting, sensitivity to light and sound when
the migraine attack began and at 15, 30, 45, 60, 90,
120, 180 and 240 minutes after taking their med-
Based on the diaries, people who took Excedrin
or ibuprofen both reported more pain relief than
those who took a placebo. Excedrin users reported
more pain relief than ibuprofen users from 45 min-
utes through four hours post medication.
At the two-hour time point, 62 per cent of
Excedrin users reported some headache relief from
the medication, compared to 54 per cent of ibuprofen
users and 47 per cent of placebo users, according
to the results published in Cephalagia.
Goldstein stressed the importance of caffeine,
which is an ingredient in Excedrin but not in ibupro-
fen. Caffeine helps the body absorb medications
and can make pain relievers more effective, he said.
But caffeine can also cause headaches, noted Dr
Douglas S. Paauw, a migraine specialist at the Uni-
versity of Washington School of Medicine in Seattle,
who was not involved in the study.
"With many doses of caffeine per week, you may
get rebound headaches," Pauuw said. "When people
overuse medications for migraine they can give
themselves chronic daily headache."
That s not the only thing he found concerning
about the analysis. Aside from being backed by the
pharmaceutical company, it was a reanalysis of pre-
vious data, which weakens the results, and a large
number of people in the placebo group reported
some headache relief, he said.
"That s pretty remarkable for the severe headache
level," he said.
He also noted that the study dosage of ibuprofen,
400 milligrams, was only about half of what he
would recommend for his patients. Each dose of
Excedrin used in the study contained 500 mg acet-
aminophen, 500 mg aspirin and 160 mg caffeine,
which is more standard, Pauuw said.
"I have a lot of patients with migraine headaches,
and they try just about anything," he said. "It s not
like this medicine is a surprise to them."
If your headaches are bad enough that you re
seeing a doctor, you probably need the prescription
level medication for them, he said. But
Excedrin could be a valid option for some
severe migraine sufferers, he added.
"We still have plenty of people in this
country who don t have medical insurance,"
he said. "They can get this without a pre-
scription and it s much cheaper."
A bottle of 100 doses of Excedrin
Migraine costs about $15 at the drugstore,
compared to $14 to $46 per pill for brand-
name prescription triptans,
according to Consumer
"Excedrin may be
appropriate for severe
migraine headaches, in a
situation where (sufferers)
may not be able to access
other medications or may not
want to take a narcotic," Goldstein
But he cautions that it should be taken
reasonably and appropriately.
"Utilisation of combination analgesics
is dangerous," he said. "Taking six to eight
pills per day, that is not the way to utilise
any analgesic product."
Always use medications as directed and
consult with a healthcare provider,
OTC drugs may alleviate
some severe migraines
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