Excedrin is one of those trusted brands that has been around for decades. According to the current manufacturer (Novartis), Excedrin Extra Strength was the first “multi-ingredient headache treatment product on the market.” It was introduced in 1960. Could stopping Excedrin suddenly lead to caffeine withdrawal headaches? One reader shared just such a situation.
There are now four Excedrin products on the market, so we need to distinguish between them. It’s easy to get confused.
- Excedrin Extra Strength
- Excedrin PM Headache
- Excedrin Migraine
- Excedrin Tension Headache
We are totally fascinated by the marketing “genius” behind Excedrin products. A standard dose of Excedrin Extra Strength (2 tablets) contains 500 mg of acetaminophen, 500 mg of aspirin and 130 mg of caffeine. An 8 oz cup of coffee has 95 mg of caffeine (according to the US. Department of Agriculture).
You might imagine that Excedrin Migraine might have some other ingredients to distinguish itself from Excedrin Extra Strength. Nope! It has the identical ingredients: acetaminophen, aspirin and caffeine in the same exact dose. The dosage instructions do vary, however. The makers of Excedrin Migraine warn people “do not take more than 2 caplets in 24 hours unless directed by a doctor.” That is one fourth the maximum dose of Excedrin Extra Strength. We wonder how many migraine sufferers read and understand that instruction.
What is the Excedrin Dosage Recommendation?
The directions on the label of Extra Strength Excedrin say:
“adults and children 12 years and over: take 2 caplets every 6 hours; not more than 8 caplets in 24 hours.”
Someone who takes the maximum dose would be getting 2,000 mg of acetaminophen, 2,000 mg of aspirin and 520 mg of caffeine. That would be the equivalent of about 5 cups of coffee in a day. Here is a question we received from a person who discovered the caffeine in Excedrin posed a problem when stopping the drug:
Q. Excedrin contains caffeine. Discontinuing Excedrin gave me a horrible caffeine-withdrawal headache. I had to cut down on the Excedrin dose gradually to be able to stop.
A. Rebound headaches can occur when people overuse their pain relievers. Experts suggest that if someone is relying on an analgesic more than 12 days a month, that is a red flag for problems. Cutting back, however, can be challenging and will likely require supervision by a headache specialist.
Caffeine can boost the pain-relieving power of aspirin or acetaminophen (Cochrane Database of Systematic Reviews, Dec. 11, 2014). Stopping caffeine suddenly, however, can also lead to a rebound headache. An article in the journal Drug and Alcohol Dependence (Aug 1, 2012) points out that:
“Habitual caffeine consumers who abstain from caffeine experience withdrawal symptoms such as headache, fatigue, difficulty concentrating, mood disturbances, and flu-alike symptoms…
“Caffeine is the most widely used mood altering drug in the world. In the United States, 87% of children and adults regularly consume caffeine, with adult caffeine consumers ingesting approximately 280 mg per day on average…
“Caffeine withdrawal symptoms typically emerge after 12-24 h of caffeine abstinence, peak in the first day or two, and last from 2 to 9 days. Caffeine withdrawal can impair normal functioning (e.g., incapacitating headache, missing work) and it has been suggested that fatigue and performance decrements resulting from acute caffeine abstinence may have important implications for safety (e.g., sleepiness while driving) and academic achievement.”
Stopping Excedrin Suddenly: Rebound Headaches?
Many people swear by Extra Strength Excedrin. When it became unavailable a few years ago because of quality issues, some people became quite desperate. The cost went up dramatically on the web. According to ABC news, the price jumped substantially with people paying “ridiculous prices on the black market.”
A headache sufferer who takes the maximum daily dose for several weeks might well experience a painful caffeine withdrawal headache after stopping Excedrin Extra Strength suddenly. You can appreciate the temptation to restart the medication to end the headache or other caffeine withdrawal symptoms such as fatigue and difficulty concentrating. Because caffeine withdrawal headaches can last for several days, this seems to us like a potential vicious cycle.
We Love Coffee:
Please do not get us wrong. We are coffee lovers. That little caffeine jolt after breakfast gets me going. But I try to keep my intake under 3 cups a day. What worries us about a headache remedy that contains caffeine is that some people may end up like the person who wrote to us. After stopping Excedrin, they might experience a caffeine-withdrawal headache.
Another Excedrin Product: Excedrin Tension Headache:
Excedrin Tension Headache is the newest pain reliever in the Excedrin lineup. It was introduced in 2003. Each caplet contains 500 mg of acetaminophen and 65 mg of caffeine. The recommended dose is:
“adults and children 12 years and over: take 2 caplets every 6 hours; not more than 6 caplets in 24 hours.”
That means someone who takes the maximum dose could be getting 3,000 mg of acetaminophen daily along with 390 mg of caffeine or about the equivalent of about 4 cups of coffee. We leave it to you to ponder the wisdom of that much caffeine on a regular basis for someone suffering tension headaches.
Learning More About Headaches:
If you would like to learn more about the dos and don’t of headache treatment we highly recommend a recent one-hour interview (Show # 1055) we did with Jennifer S. Kriegler, MD, titled “What are the Best Treatments for Headaches?”
Dr. Kriegler is director of the Headache Medicine Fellowship at the Cleveland Clinic. She is part of the Center for Neurological Restoration and the Headache Section of the Neurological Institute in the Department of Neurology of the Cleveland Clinic. The MP3 download is free, but only for another week.
Share your own thoughts about headache remedies in the comment section below.