Is Tylenol or Ibuprofen Better for My Headache?

It's not a slam dunk answer, but many experts lean towards an NSAID

Advil vs Tylenol for Headache Relief
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If you suffer from occasional tension headaches, you may wonder what pill bottle to reach for in your desk drawer or medicine cabinet at the onset of an attack. What is more effective? Tylenol or ibuprofen?

Let's investigate this question further.

What is the Treatment of Tension-Type Headaches?

Typically, people with tension headache self-treat with over-the-counter medications and other non-medical therapies like sleep, exercise, hydration, and caffeine.

People tend to go to a doctor's clinic only when their headache is resistant to these therapies, or when they experience other symptoms in addition to their headache, such as visual changes from an aura—this actually suggests a diagnosis of migraine and not a tension headache.

Classic examples of over-the-counter medications for tension-type headaches are:

What Does Research Say About Ibuprofen versus Tylenol?

So which bottle do you grab from your medicine cabinet or desk drawer? Well, either would most likely work, although ibuprofen may be more effective.

In an older study, in the Journal of Clinical Pharmacology, over 450 individuals with tension headache were randomized to receive either 400mg ibuprofen, 1000mg of Tylenol, or placebo. Results showed that both ibuprofen and Tylenol were more effective than placebo in alleviating headache, and ibuprofen was found to be more effective than acetaminophen.

That being said, other studies have found no difference between Tylenol and NSAIDs in alleviating tension headache pain.

For example, a review study in Pain found both Tylenol (1000mg dose) and ibuprofen (400mg dose) to be better than placebo at easing moderately to severely painful tension headaches (using the parameter of being pain-free two hours after taking the medication).

Neither was found to be more effective than the other.

The study also found that the number of people needing to take either Tylenol or ibuprofen to obtain headache relief at two hours was nearly 9 for both. This is rather high and means that there is still a lot of people who are not getting proper relief—a bit of an unsettling feeling.

The Answer: Ibuprofen Versus Tylenol

So the answer is that either Tylenol or an NSAID is a reasonable first-choice option for alleviating your tension headache. In terms of dosage, a 200 or 400mg dose of ibuprofen is a typical dose. If you take naproxen sodium (Aleve), a typical single dose is 220 or 550mg.

Remember, though, that NSAIDs do have several potential adverse effects and should be avoided by some individuals, particularly those with a history of stomach bleeding, kidney disease, and/or heart disease.

In addition, if you are pregnant, acetaminophen is generally the preferred choice for a tension headache, although be sure to confirm with your obstetrician. In general, it is important to always speak with your healthcare provider before taking any medication, including those that are over-the-counter, to make sure it is safe for you.

Finally, if you have frequent or chronic tension headaches, it's not good to regularly take analgesics for pain control.

This can actually backfire and cause a medication-overuse headache, which can be difficult to distinguish from your regular tension headaches—a double whammy, so to speak.

A Word from Verywell

If you have episodic tension headaches and want to take an over-the-counter medication, either ibuprofen or Tylenol is a sensible choice. You may get more benefit from ibuprofen, but this is not a hard and fast rule. As always, speak with your doctor before you take any medication.

Sources:

Diener HC. Headache: insight, understanding, treatment and patient management. Int J Clin Pract Suppl. 2013 Jan;(178):33-6.

Moore RA, Derry S, Wiffen PJ, Straube S, Bendtsen L. Evidence fo efficacy of acute treatment of episodic tension-type headache: methodological critique of randomized trials for oral treatments. Pain. 2014 Nov;155(11):2220-8.

Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol. 1996 Dec;36(12):1120-5.

Taylor FR. Tension-type headache in adults: Acute treatment. In: UpToDate, Swanson JW (Ed), UpToDate, Waltham, MA.

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