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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.
Doc
Cent-NE Cali/NE-Cent Nevada
Terry Graedon — Thank you for correcting me and the math – I (obviously) did not catch the single dose as being two caps/pills. Acetaminophen (APAP) is one of those ‘shadow’ drugs which seem to pop up all over because it’s used in SO many different drugs as only a portion of the ‘pharmacy’ now contained in single multi-purpose pills, and when used with Alcohol (COOH) over an extended period can cause NOT just hepatic (liver) damage (close to exponential curve when both are used together), but now has been shown to have a link to early-onset Dementia.
So add APAP to COOH and it’s not really the death that’s the problem (IMHO) it’s the suffering that one goes through to FINALLY get to death, just as dementia is not really the problem, it’s having to go THOUGH dementia before you die, and the burden one puts on caretakers during the time when a person needs care before they die that’s the problem.
Thanks again for the correction. Being wrong is the easy part of learning! Accepting that one has been wrong is often the greater stumbling block! Thanks again – Doc
Sharon
NC
It should be mentioned that Acetaminophen is in a lot of aspirin products. It alone has a warning on the label about liver damage, especially for older people. I’ve read recently that emergency rooms in U.S. has more visits because of Acetaminophen than just about any other cause.
Carol
Dallas, Texas
Carol T, now age 80, used to have migraines so severe that she would begin vomiting and not be able to stop for several hours; sometimes would spend time in the hospital so that they could control it before the prescription medicines became available. The Extra Strength Excedrin was the best thing available until then; if it would stay down! This article is very interesting; I don’t have those headaches any more, but remember them well.
joy
I don’t know how it can be said that Excedrin was “the first multi-ingredient analgesic on the market”. This is so false! Old fashioned APC tablets, containing aspirin, phenacetin, and caffeine were first formulated in 1919, according to wikipedia.They were widely given out during WW II as my father was given them.
Doc
NC-E.Cali/NE-N-C Nevada
Caffeine is one issue, but a more serious one – I would think – is the relatively high dose of APAP, which approaches the dose at which hepatic damage begins to occur. The USDA sets 4g as the MAX dose per day. I see Extra Strength with 500mg not to exceed 8 caps a day, that is 8 x 500mg = 4.5gr a day.
That puts normal people at risk for hepatic damage, and those with pre-exisitng liver conditions at even more risk. Did I do my math wrong, or is that a greater concern – especially if COOH (alcohol) use is involved at =/> 1 lq. Ounce a day? Am I missing something here? Daily use of Extra Strength (4.5g/day) and >/= 1 lq. once of Alcohol a day would seem to be headed down a potentially dangerous path. I would like clarification on this if possible.
Terry Graedon
The math is wrong. The 500 mg is in a single dose: two capsules. So eight capsules in 4 X 500 = 2,000. That said, we are also very concerned about overuses of APAP.
Doc
N
Caffeine is one thing, APAP is another – isn’t that getting VERY close to the daily max dose before hepatic damage can start to occur?
Charlotte
Brazoria TX
I take 1 Excedrin extra strength tablet when I have a headache and 15 minutes later my headache is gone, Tylenol does absolutely nothing for my headaches. I rarely need more than 2 tablets in one day so never had withdrawal problems. I have taken Excedrin for many years and think it is a very good product but with every medicine read the instructions and check with your doctor to see if there might be interactions with any other medicines you take including supplements.
Laura
This past September I stopped taking the generic version of Extra Strength Excedrin. I never exceeded the dosage recommendations per day, but I took it almost daily at times for many, many years to help with excruciating barometric headaches. I decided to stop and have not had any sort of pain reliever since. I experienced no problems/withdrawal at all. I did start taking a Beet Root Supplement about the same time which ended up taking care of my barometric headaches ~ a real surprise for me. I now take L-Arginine and am having the same results.
Cindy
northern California
I noticed that Excedrin Migraine ingredients were exactly the same as Extra Strength Excedrin some years ago. I consider that nothing short of dishonest so stopped buying any Excedrin product. I hate being lied to. But here is the conundrum ~ I’ve told others who take the Excedrin Migraine that it has nothing different in it and they generally don’t believe me. They say it works
better. The power of suggestion ~~ One source has the price at 2 cents more a pill for the “Migraine” versus “Extra Strength”.
Mari
I wish they would bring back Excedrin Mild. Stores stopped carrying it this year and when I called the company, all they would tell me is that it had been discontinued. Does anyone know why?
Noah
Chapel Hill, NC
I used excedrin for thirty+ years (last twenty or so the Wal-Mart Equate brand and other “generic” excedrin) taking (I know, but I did) as many as eight to ten or more every day to deal with the pain of an injury. About twenty months ago I had an unrelated stroke and had to stop the excedrin ‘cold turkey.’ Zero rebound effect.