What I Wish More People Knew About ‘Safe’ Over-the-Counter Headache Medications

“I’ve had this headache for weeks. I take something, it helps for a couple of hours, and then it comes right back.”

As a neurology resident, I hear a version of this all the time from patients who have been self-treating headaches for months, or even years, with over-the-counter (OTC) painkillers like acetaminophen (Tylenol), ibuprofen (Advil), naproxen (Aleve), aspirin, and combination products such as Excedrin.

Millions of American adults experience headaches, and according to a 2021 National Health Interview Survey, around 4% of U.S. adults report being “bothered a lot” by the condition in the last three months. For both tension-type and migraine headaches, OTC medications like ibuprofen can provide relief, which helps explain why so many people rely on them.

But that reliance can have consequences. Few people realize that frequent use of these medications can actually worsen headaches, leading to a condition called medication overuse headache (MOH). It’s a paradox that surprises almost everyone I explain it to: the very pills meant to relieve pain can end up fueling it.

Medication Overuse Headache: How Short-Term Pain Relief Can Backfire

MOH typically occurs when OTC painkillers aretaken more than 15 days a month for several months. Around 1 to 2% of the global population is currently living with MOH, but rates soar to 11 to 70% in people with chronic headaches, particularly those with migraine. Women seem to be significantly more likely to develop MOH, with the condition most commonly affecting people between the ages of 30 and 50. Additional factors such as smoking, physical inactivity, and anxiety or depression symptoms have also been associated with MOH.

While more research needs to be done, recent literature suggests that frequent use of OTC painkillers may gradually blunt the brain’s ability to regulate pain. Over time, the systems that normally dampen pain signals seem to become less effective, leaving ‘headache pathways’ to become easier to activate.

People living with migraine may be especially prone to managing their symptoms with over-the-counter medications, in part because these drugs are widely available and often treated as low-risk. More than half of those who experience migraine attacks say they rely on OTC medications, and approximately 30% treat their headaches exclusively with these drugs. 

Over-the-counter medications are deeply embedded in daily life. According to a report by the Consumer Healthcare Products Association (CHPA), 81% of adults use OTC meds as a first response to “minor” ailments. When that widespread use is considered alongside evidence from a large review of more than 50 studies showing that roughly one in six people misuse OTC medications, with painkillers among the most commonly misused, it raises important questions about the risks of routine self-treatment.

One of the most effective ways physicians can help patients avoid MOH is by starting those with frequent or chronic migraine headaches on preventive therapy, while gradually reducing their reliance on OTC painkillers. These preventive options can include nutrients like magnesium and vitamin B2, daily medications such as beta blockers, SNRIs, and CGRP-targeting drugs, as well as Botox injections every three months. I’ve seen several patients with near-daily headaches experience dramatic improvement after making this shift. Once on preventive treatment, many were able to cut back on OTC medications and now report headaches only once every few weeks or months.

Other lifestyle changes, such as improving hydration, avoiding certain foods, and getting regular sleep, can also help reduce headaches and lessen the need for OTC medications.

When Self-Treatment Gets in the Way of Answers

Another problem with self-medicating headache pain is that many people who rely solely on OTC pain relievers have never seen a doctor to confirm the underlying cause of their condition. Different headache types require different treatments, and in some rare cases, a medical evaluation is necessary to rule out serious conditions like infections or tumors. Yet millions of people are still treating symptoms first and asking questions later — if they ask at all.

I’ve seen this firsthand. I’ve treated many people who spent years taking daily OTC medications, only to discover through careful history and examination that their symptoms were more consistent with sleep apnea. Once they began the proper treatment for the condition, their headaches improved significantly, and they now use OTC medications only occasionally.

What I see in my patients with headaches is part of a larger issue when it comes to managing chronic symptoms: treating them in isolation, without medical guidance. 

OTC drugs can be safe and effective when used occasionally and as directed. The trouble starts when they quietly become a long-term fix without any additional input from a doctor. What I’d love for my patients — and really, anyone — to ask before reaching for that next pill is this: Are you treating a one-off symptom, or masking a bigger problem that deserves a closer look?

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