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Boggio Family of Pharmacies

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Category Archives: Migraine

There is often a great deal of confusion when it comes to over-the-counter products that contain Tylenol (acetaminophen), Aspirin (acetylsalicylic acid), and ibuprofen

Ibuprofen and Aspirin are similar products.  They are both part of a class of medications called non-steroidal anti-inflammatories (NSAIDS).  They are good for treating fever, pain, and inflammation.  These medications help with arthritis, dental pain, and pain from broken bones and sprains.  Ibuprofen is the medication found in Advil and Motrin.  There is a new medication available over-the-counter in Canada called Aleve.  It is also a good anti-inflammatory medication and can be used for the above purposes.

Anti-inflammatory medications are quite effective and can often be used in place of narcotics for short term pain management.  However, not everyone should be using these products, and most people should avoid daily long-term use.  NSAIDS, with long-term use can cause stomach erosion, ulcers, and bleeding.  For patients on warfarin they are particularly dangerous because they can further increase a patient’s risk of bleeding.  They can also raise patient’s blood pressure and damage their kidneys.

Aspirin should not be given to children, asthmatics, or pregnant women.  Some over-the-counter medications contain Aspirin and people may be unaware of this.  For example, Pepto-Bismol and some other antacids contain Aspirin.  If you are unsure please ask your pharmacist if certain OTCs are safe for you.

There are number of arthritis rubs and creams available.  Some of these contain Aspirin and other types of NSAIDs  If you are on warfarin or have problems with your stomach you should be careful with the use of these products.  They still get absorbed in to your blood stream and can have negative effects.

In recent months there have been some media reports encouraging people to take 400mg of ibuprofen twice a week for its general anti-inflammatory properties.   It is thought that inflammation may be involved in the formation of some cancers, such as colon cancer; therefore taking ibuprofen may play a role in helping to prevent some cancers.  However, further research needs to be done in this area for confirmation of results and safety. It is also suggested that if you are at any risk for heart disease or stroke you take a daily 81mg Aspirin.  Talk to your doctor if you think you could benefit from these preventative strategies.

Tylenol (acetaminophen) is used to treat pain and fever.  Tylenol does not have the same anti-inflammatory properties that Aspirin or ibuprofen has but it is safer for some people to take.  For patient’s with arthritis who can’t take NSAIDS it is the next best option.  Tylenol is metabolized through the liver so it is best not taken by individuals with any type of liver disease. There is also a limit to the amount of Tylenol a patient should take in a day.  People should not exceed more than four grams in a day.  There are many cough and cold products that contain Tylenol.  Please ask the pharmacist if you are taking multiple products.

Ibuprofen and Tylenol can be taken together.  Typically ibuprofen should be given every 6-8 hours and Tylenol can be given every four to six.  If you have a young child with a high fever it is okay to give Motrin every six hours and the Tylenol in between.  It may provide some additional benefit and keep the fever down in between doses.

In general Tylenol, and NSAIDS are safe and effective for most people.  These medications work very well and can provide much comfort and relief.  If you are unsure what the best product is for you, your pharmacist will be happy to help you.


Many people suffer from migraine headaches.  In fact, most headaches are migraines.  Symptoms include moderate to severe pain, which may be confined to one side of the head or affect both sides.  Pulsing or throbbing pain.  Pain that worsens with physical activity.  Nausea and or vomiting.  Sensitivity to light and sound.

Some migraines are proceeded by an Aura (changes to vision, flashes of light, feeling of pins and needles in an arm or leg), and others are not.

The cause of migraines is not completely known but it is suspected that they result from changes in the trigeminal nerve, and/or imbalances in chemicals in the brain like serotonin.

There are a number of different triggers for a migraine.  Understanding these may help people avoid them.  The first is hormonal changes in women.  Fluctuations in estrogen can trigger a migraine.  Often women report a headache immediately before or during their periods when they have a drop in estrogen.  Oral contraceptives and hormone replacement therapy can sometimes worsen migraines.  However, some women find it useful to take a monophasic birth control pill without a rest period between packages.  This can help to keep estrogen levels constant

Migraines can also be triggered by certain foods.   The most commonly reported are; alcohol (especially beer and red wine,) aged cheeses; chocolate; aspartame; overuse of caffeine; MSG; salty food; processed foods; and foods containing nitrates like hot dogs and salami.

Eliminating gluten from the diet has been shown to reduce migraines in some people.  Migraine sufferers were ten times more likely than the general population to have Celiac disease (a disease characterized by an intolerance to gluten).  Patients on a gluten-free diet have been shown to have a decrease in migraines.  (Celiac testing can be performed at certain pharmacies).

Other triggers include, stress, bright lights, loud sounds, unusual smells, changes in sleep patterns, physical exertion, a change in the weather and certain medications.

Treatments for migraines are readily available.  Some over the counter remedies include non-steroidal anti-inflammatory drugs like Advil.  A good starting dose is 400mg.  You need to make sure it is safe for you to take this because it can cause side effects such as stomach ulcers, and an increased risk of bleeding.  Tylenol can also provide some benefit.  A good starting dose is 500mg.  Patients need to be careful they do not exceed four grams of Tylenol a day as it can cause liver toxicity.  Caffeine is also recognized as a treatment for migraine when it is combined with Tylenol and Aspirin.

One thing to be aware of is that if you take these headache medications more than nine days a month in high doses you may be at risk for rebound headaches.  This can occur when your medication not only stops relieving the pain but actually begins to cause headaches.

Antiemetics such as Gravol can also help relieve symptoms of nausea and prevent vomiting.  This improves the effectiveness of the oral medications taken.

Serotonin agonists like Zomig and Imitrex require a prescription but can be very effective.  These medications are also quite expensive but are usually covered by drug plans.  It is best to take these medications at the first sign of a migraine for them to be most effective.

Tricyclic antidepressants such as Amitriptyline have been used to prevent migraines but they have some adverse effects such as insomnia, sedation, sexual dysfunction, and withdrawl symptoms.

Some herbal treatments have shown some evidence of effectiveness.  These include feverfew, butterbur, riboflavin, and Coenzyme Q10.  Of course you should consult your physician to see if it is safe for you to take these, and pregnant women should avoid them.

Migraines can be debilitating.  If you are a chronic migraine sufferer there are steps you can take to avoid the number of attacks, and there are safe effective medications you can take to help eliminate them.  Talk to your pharmacist to see what approach is best for you.