Reader’s Mail: Recommended Doses of Acetaminophen, Aspirin, Caffeine and Excedrin®

News to Know

Q. Excedrin Extra Strength gelcaps each contain 250 mg. of acetaminophen, 250 mg. of aspirin and 65 mg. of caffeine. Excedrin Migraine caplets contain exactly the same amounts of each ingredient. However, the first product allows the use of eight gelcaps in 24 hours, whereas the latter only allows the use of two caplets in 24 hours. Why the difference in the allowable use of two pills of apparently the same medication?

A. The Excedrin Migraine recommendation is lower to avoid developing medication overuse headache. An advisory committee of the Food and Drug Administration also made the following recommendations for the use of acetaminophen in order to reduce the incidence of liver injury: 1) the single adult acetaminophen dose should not exceed 650 mg. and 2) the maximum total daily recommended dose should be no more than 2,600 mg/day.

In regards to aspirin and caffeine: 1) the maximum daily dose of aspirin should not be more than 4,000 mg/day, an amount that is actually inappropriately high for headache treatment, and 2) caffeine ingestion should be limited to no more than 1-2 8-oz cups per day in migraineurs in order to minimize the risk of developing withdrawal headaches or medication-overuse headaches.

If you are using moderate to large quantities of acetaminophen or aspirin, it should only be under the supervision of a healthcare professional. Additionally, escalating frequency of use, or the use of moderate to high doses of over-the-counter (OTC) medications, should prompt you to seek your doctor’s advice. Other options may be available for you.

Finally, all drugs, including OTC medications, have potentially serious side effects if overused. In this case, you should be aware that gastrointestinal discomfort and even bleeding can occur with aspirin use and liver toxicity can occur with the use of acetaminophen when taken at high doses.

Barbara Lee Peterlin, M.D.
Drexel University of Medicine
Philadelphia, PA

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How Much Caffeine in a Cup of Coffee? Discover the Caffeine Content of Your Favorite Drinks

Do you feel like a zombie without your morning cup of coffee? Or, maybe you find yourself reaching for an afternoon iced coffee or an energy drink for that extra pick-me-up. If so, you’re far from alone. Especially here in the migraine community, we know that too much of anything usually isn’t a good thing. Like many people, you could be overindulging in caffeine, and it might be affecting your migraine condition.

Migraine or not, we are a coffee drinking culture. In 2020, the National Coffee Association (NCA) released a survey that shows that 62% of Americans drink coffee every day — with an average of about three cups a day — a 5% increase in coffee consumption since 2015. 

That comes as no surprise, seeing as you can hardly go anywhere these days without seeing coffee shops like Dunkin’ Donuts and Starbucks dotting every corner. But do you really know the caffeine content in that cup of coffee you’re grabbing at the drive-through on your way to work? Or how caffeine affects you?

Before you order your next double shot or cold brew coffee, here are a few things to keep in mind about that happy little molecule we call caffeine.

What is Caffeine?

Caffeine is a natural stimulant that has been around since the 18th century. It provides us with boosts of energy, heightened alertness, and increased mood. Once caffeine is absorbed into the bloodstream, it travels to the brain. It then stimulates the neurotransmitters adenosine, dopamine, and norepinephrine, causing excitability of the nervous system.

While most people probably think of coffee when they hear the word caffeine, the truth is that caffeine can be found in some pretty surprising items such as chocolate, some over-the-counter and prescription medications, certain dietary supplements, packaged foods, coffee-flavored ice cream, and even some chewing gums. And of course, it’s prevalent in energy drinks, many soft drinks, and certain teas.

More from Migraine Again

Caffeine Content in Foods and Medicine 

The key to monitoring your caffeine intake is to read labels carefully. However, this is tricky because the FDA currently does not require the caffeine quantity to be indicated on beverages or foods. 

And thanks to those sneaky sources, you may be consuming even more caffeine than you thought.

You may be wondering, how much caffeine in a cup of coffee or in your favorite coffee drinks? Or, does green tea have caffeine? How much caffeine does chocolate have? Are decaf beverages truly caffeine-free?

This handy chart will give you an idea of how much caffeine you might be consuming in certain foods, drinks, and medications: 

How Much is Too Much Caffeine?

If you are a daily caffeine drinker, you might notice needing to drink more over time to feel the effects. That’s because the more you ingest long term, the higher your tolerance; your body will demand higher quantities to produce the desired effects. Where one cup of brewed coffee in the morning may have gotten you through the day, you may find yourself craving a Starbucks coffee or an espresso-based drink by lunchtime. 

Caffeine absorbs within 45 minutes after ingestion and peaks in the blood anywhere from 15 minutes to two hours after consumption. 

Experts suggest that caffeine intake of 400 mg a day is considered safe in healthy individuals.   

Anything more than that and you could be in for a nasty case of the jitters for a few hours, or worse: Caffeine in large quantities can cause an overdose, although that’s rare. The U.S. National Poison Data System received over 48,000 caffeine-related calls between 2000-2014. Symptoms of caffeine overdose can include:

• Vomiting
• Hallucinations
• Disorientation
• Seizures
• Chest pain

The effects of caffeine will vary depending on amount of consumption, as well as the age, gender, weight, and water intake of the person ingesting it. 

And for those of us with migraine, caffeine can be both friend and foe. Sometimes it can help stop a migraine attack or headache in its tracks, but on the other hand, withdrawal from it can trigger one.

Caffeine and Headaches

Many people with headache and migraine tend to reach for a caffeine-containing product — such as Excedrin Migraine, which contains 130 mg of caffeine per two-capsule dose — to ease head pain. This caffeine content may seem like a reasonable amount in the short term, but combining it with other caffeine-related products can quickly add up, and pretty soon you’re consuming more caffeine than you realized. Long-term usage of some pain relievers, especially those containing caffeine, can lead to medication overuse headache (also known as medication adaptation headache). 

The International Headache Society suggests that regular consumption of caffeine in doses of more than 200 mg per day can cause headaches. 

Long-term use of caffeine produces overstimulation of adenosine receptors. 

At the same time, when caffeine ingestion is abruptly stopped, vasodilation of the blood vessels expands and increases the flow to the brain, causing head pain.

Why is Caffeine Used in Some Medications?

Caffeine is considered an adjuvant therapy, which, put simply, means that it magnifies the effects of other medications. Studies show that combining caffeine with aspirin and acetaminophen increases the strength by 40%. That explains why caffeine is an active ingredient in so many of the medications people with migraine reach for, including Excedrin Migraine, Excedrin Tension Headache, Fioricet (butalbital/acetaminophen) and even certain brands of cold medicines. 

How to Safely Cut Back on Caffeine

Once you have an idea how much caffeine you’re really consuming, you might decide it’s time to cut back. But how can you do that without triggering a headache or migraine attack? Here are a few tips:

• Take it slow and steady.
• Keep track of your daily caffeine consumption, and substitute with non-caffeinated beverages — ideally, water. To break a caffeine addiction with minimal side effects, you will need to do this for weeks continually.
• Adjust your brewing method on caffeinated teas. Shortening the brew time results in less caffeine, while a longer brew time results in slightly more caffeine.

If you love coffee and tea and don’t want to give them up completely, perhaps an obvious solution is to switch to decaf. But even that’s not so simple.

Are Decaf Beverages Really Caffeine-Free?

Before you order your next decaf beverage, you might think by name, it means there is no caffeine. But while the decaffeination process removes about 97% of caffeine, there is no way to eliminate caffeine entirely, unfortunately. And since the FDA does not regulate decaf beverages, there may still be trace amounts in drinks. A cup of your favorite decaf black tea or coffee still has a range of about 2-4 mg of caffeine remaining.

How is Caffeine Removed From Beverages?

The decaffeination process of coffee involves the use of chemicals, usually ethyl acetate or methylene chloride. Coffee beans can either be steamed and raised with these chemicals or processed in a caffeine-loaded water bath for hours. In both cases, coffee-bean-flavored solution is added back to the beans. Some people don’t like the chemical aspect of the decaffeination process, which is why the Swiss Water Process (SWP) is an attractive healthier option. This patented method results in a chemical-free, naturally decaffeinated beverage in which 99.9% of the caffeine content has been removed. Sounds great, right? Let’s dig a little deeper. 

What is the Swiss Water Process?

The Swiss Water Process works by soaking coffee beans in water to discard caffeine using activated carbon filters. Decaffeinating the beans before they are roasted and ground helps retain the flavor profile minus the caffeine. In other words, those brain-boosting antioxidants and that earthy taste so many people love and crave are preserved. 

This could be an excellent alternative for those who don’t like the sometimes weird after-taste of decaf coffee. Vestibular migraine patient and author of “The Dizzy Cook” Alicia Wolf recommends mixing your regular coffee with SWP decaf, gradually decreasing the amount of your regular coffee over time.

Caffeine-Free Alternatives

But what if coffee isn’t your, well, cup of tea, but you still want that energy boost sans caffeine? Fortunately, there are alternatives for the Starbucks-averse among us:

• Chicory root is a woody, herbaceous plant that has a similar taste to coffee. It also has the benefits of supporting healthy digestion and gut bacteria.
• Rooibos tea has a sweet, earthy taste and contains antioxidants that boost overall health.
• Herbal teas such as turmeric, peppermint, and ginger teas have specific health benefits, such as reducing inflammation, digestive discomfort, or nausea.
• Sparkling water is an attractive alternative option to soft drinks. It provides hydration with fewer calories. Plus, it offers the same bubbly effect as your favorite soda.
• Carob is a fruit derived from the pods of the carob tree. It is often used as substitute for chocolate, but it’s naturally sweeter, thanks to the high sugar content. “The flavors will be a bit different between carob and cocoa,” says Margaret Slavin, associate professor of nutrition and food studies at George Mason University. “The extraction of caffeine and its cousin, theobromine, makes carob less bitter.” This might be worth a try if you’re looking for a caffeine-free chocolate dupe.

Is Caffeine a Trigger or a Treatment?

It seems there is a love-hate relationship with caffeine when it comes to helping or hurting our heads. “I think one concept that is a bit overlooked is that of [caffeine as] a trigger,” says Cynthia E. Armand, MD, assistant professor of neurology at the Albert Einstein College of Medicine. “Caffeine is a commonly reported migraine trigger; however, that is not the case with all individuals living with migraine. If one is curious about individual effects of caffeine, an intake diary can be elucidating,” she advises.

Here is what a few people in our community had to say:

“Sometimes it seems like a trigger, other times it doesn’t. It’s a lottery!” says Katie C.

“Sometimes it helps me, and sometimes it makes it worse,” says Ivonne C.

“Sodas and coffee are OK; however, energy drinks provide instant pain,” says Kaitlin H.

“I drink two cups of coffee each morning; no more unless a migraine attack begins, then a strong cup of coffee with meds helps,” says Norma M.

It’s clear that we do love to consume caffeine. And while there’s no reason to completely ditch your beloved coffee beans or English Breakfast tea bags, it’s a good idea to keep your favorite drink’s caffeine content in mind. Like everything else, caffeine should be enjoyed in moderation. Keep track of how caffeine consumption affects your migraine attacks, and watch for it in those sneaky, surprising sources. And the next time you roll through that drive through, or reach for that energy drink or piece of chocolate when you’re dragging in the afternoon, reference the above handy chart to see just what kind of a jolt you’re in for.

Editorial Sources and Fact Checking

Sources

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• Kole J, Barnhill A. Caffeine Content Labeling: A Missed Opportunity for Promoting Personal and Public Health. Journal of Caffeine Research. September 2013.

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• Does Caffeine Trigger or Treat Headaches? National Headache Foundation. 2019.

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• Tornstrom K. Does caffeine treat or trigger headaches? Mayo Clinic Health System: Speaking of Health. October 2020.

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• Caffeine. Harvard: The Nutrition Source.

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• Nawrot P, Jordan S, Eastwood J, et al. Effects of caffeine on human health. Food Additives and Contaminants. January 2003.

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• Understanding Caffeine Headaches. American Migraine Foundation. December 2017.

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• Neves Da Silva A, Lake A. Clinical Aspects of Medication Overuse Headache. The Journal of Head and Face Pain. October 2013.

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• Espinosa Jovel CA, Sobrino Mejia FE. Caffeine and Headache: Specific Remarks. Neurologia. July-August 2017.

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• Fried N, Elliot M, Oshinsky M. The Role of Adenosine Signaling in Headache: A Review. Brain Sciences. March 2017.

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• Lipton R, Diener HC, Robbins M, et al. Caffeine in the management of patients with headache. The Journal of Headache and Pain. 2017.

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• Decaffeinated Coffee Beans. Coffee Research Science.

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• Decaffeinated Coffee Beans. Coffee Research Science.

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• McGuire S. “Institute of Medicine. 2014. Caffeine in Food and Dietary Supplements: Examining Safety—Workshop Summary. Washington, DC: The National Academies Press, 2014.” Advances in Nutrition. September 2014.

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• Ramalakshmi K, Raghavan B. Caffeine in coffee: its removal. Why and how? Critical reviews in food science and nutrition. September 1999.

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  Martínez Leal J, Valenzuela Suárez L, Jayabalan R. A review on health benefits of kombucha nutritional compounds and metabolites. CyTA: Journal of Food. 2018.

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Headache pills

Types

Conventionally, all headache pills are divided into three types: simple analgesics (paracitamol, ibuprofen), ternary (a combination of three main components: ASA + phenacetin + caffeine), quintuplets (represented by the formula: 2 analgesics + codeine + sleeping pills phenobarbital + caffeine).

Depending on the formula of manufacture, all headache preparations can be classified into:

• Simple analgesics. The composition of such drugs includes only one active ingredient – analgin. Also, the basis of the drug can be paracetamol, acetylsalicylic acid or ibuprofen. These drugs are sold without a prescription. The paracytamol group includes: Paracetamol, Efferalgan, Panadol, Kalpol, Strimol, Flutabs, Daleron. To ibuprofens: Ibuprofen, Brufen, Nurofen, Solpaflex, MIG, Faspik, Advil, Bonifen, Pedea, Deblok, Ibalgin.

• Triads. The drugs in this group contain caffeine and two analgesics (usually phenacetin and ASA). The main thing here is caffeine, which can enhance and prolong the analgesic effect. Interestingly, this group also includes “twos” – those that contain only one analgesic. Among the common “triad” medicines, there are: Citramon P, Excedrin, Citrapar, Cofitsil-Plus, Aquacitramon, Citrapak. All of them are created according to a formula that combines caffeine, ASA and paracetamol, while drugs such as Caffetin SK, Novalgin, Gevadal, Saridon, Flucomp Extratab are based on propyphenazone, caffeine and paracetamol.
• Pyaterchatka – medicines based on the combination of 5 components: 2 analgesics, sleeping pills phenobarbital, codeine and caffeine. Codeine has an analgesic effect, enhancing the effect. Sleeping pills and caffeine also have an intensifying effect. The most popular types of such drugs are Sedalgin-Neo, Pentalgin-ICN, Sedal-M.

What symptoms should be used

Headache can be of different nature. The most common type is migraine. A migraine is a severe, prolonged headache that can last from 3-4 hours to several days. The head can hurt on one or both sides, mainly localized in the frontal part and in the temporal. The pain is characterized by throbbing, may be accompanied by vomiting, nausea, increased by bright light or noise.

Another type of pain is tension pain. It is formed due to a long stay of a person in one position, as well as during emotional stress, it can be caused by fatigue. Such pains are not characterized by intensity, as a rule, they are dull and aching. There will be a feeling of tightness in the head. The duration of such discomfort is from 30 minutes to a couple of hours.

Another type of headache is vascular headache. It occurs with hypotension or hypertension. To treat such an ailment, drugs should be used to increase (in case of hypotension) or lower (in case of hypertension) blood pressure. You can take such medicines only after being prescribed by your doctor. Analgesics usually provide significant relief.

Therapeutic effect

There are several main headache medicines that have certain effects on the body. For example:

• Analgin – eliminates migraines, relieves spasms that were triggered by various inflammatory processes. Permissible daily intake: 1 tablet 2 or 3 times a day.
• Solpadeine is one of the newest drugs based on paracytamol, caffeine and codeine phosphate. Not only relieves headaches, but also acts as an anti-inflammatory and antiviral medication.
• Tempalgin is an analogue of analgin, which includes tempidone. It relieves not only headaches, but also toothache. Apply 1 tablet no more than 3 times a day.
• Pentalgin – may contain anaglin, caffeine, amidopyrone. Promotes the normalization of sleep and is characterized by a sedative effect.
• Citramon is one of the most common drugs for this disease. It contains caffeine, citric acid. The use is possible on 1-2 tablets 2-3 times a day.

Contraindications

Headache tablets are contraindicated in case of any allergic reactions to the components contained in them, with open or closed bleeding (except menstrual), in case of stomach ulcers, exacerbations of intestinal diseases, during pregnancy (only with permission doctor), with defects in the kidneys and liver, with diseases of the cardiovascular system.

Does someone drink Excedrin from the head?

Forums

Input

10/24/2021 09:35

I have a non-medical question. so I ask you not to endure in health. I don’t know, maybe there are other such tablets … They are not removed from the blister. Those. we are accustomed to pressing citramon from the convex side and the tablet pops out. and here – no way, such a dense foil and apparently reinforced with polyethylene … is it done on purpose ??? For what??? and how do you dig it out? I can only use a knife, but it’s strange, what if you need it in the subway, in the office …. what is the logic of such packaging?

Anonymous

10/24/2021 09:38

Drink these separately. Excedrin – active ingredient: Acetylsalicylic acid + Caffeine + Paracetamol (Acetylsalicylic acid + Caffeine + Paracetamol)

Anonymous

24.10.2021 09:44

no, from a medical point of view, everything suits me, and there are no questions. with an economic question. or on the issue of curvature. why doesn’t he pull out?

Anonymous

24.10.2021 09:53

You will be sold an antibiotic rather than caffeine)))

EkateRina 422830 SD

10/24/2021 10:59

But on the packaging of Citramon, the composition also says “caffeine monohydrate 30 mg” – is that a lie or something?

I’m not your pussy H*

24.10.2021 14:28

did you mix it up with codeine?

Anonymous

10/24/2021 18:51

caffeine is sold quite calmly. And in pharmacies in various preparations, and in stores as part of coffee)))

Anonymous

24.10.2021 23:26

these are our pharmacists)))

Anonymous

10/25/2021 00:20

Try to remove the top layer of the foil, after the tablet is easily squeezed out of the blister.

Anonymous

10/25/2021 07:39

does not peel off, it is tightly glued. that’s the question!

Anonymous

10/24/2021 09:52

Is there by any chance a “tail” that you need to pull to remove the top part of the foil? Excedrin did not drink, but there are drugs in which the blister opens if you pull on it))

EkateRina 422830 SD

10/24/2021 09:56

you are thoughtful!!! I went to explore, I broke my eyes, there is no tail (((there is a strange one – this type of micro cut with a scissors icon, from the edge of the blister to the pill – but the plastic just cracks on it and stops at the border of the pill. You still can’t get the pill ((((how foil does not stick with yogurt (((

Anonymous

10/24/2021 10:31

There are no devices for extracting the pill. She herself suffered with them for some time, then she simply switched to other tablets. Ibuklin is no worse, if anything. And if I have a migraine, then I eat all sorts of triptans.

Babls KF

24.10.2021 13:00

What are triptans?

Anonymous

24.10.2021 14:45

this stuff

Anonymous

10/24/2021 12:42

better buy pentalgin, it helps a lot from the head

Anonymous

10/24/2021 13:07

googled a photo of a blister there is a mark on each compartment with a pill, which, apparently, needs to be cut with scissors (the scissors are drawn) maybe this is a break line, try

Anonymous

10/25/2021 07:40

yes, there is a risk, there is a rupture of the flat part along it to the body of the tablet, and this does not help to get it in any way.

Anonymous

25.10.2021 08:09

it formally exists, but the task does not make it easier. you break all your fingers until you take the pill

Anonymous

10/25/2021 08:11

fingers never worked

Anonymous

24.10.2021 23:28

only Citramon for 20 rubles per package

Anonymous

10/25/2021 07:46

Once again, I have no task to replace the drug with something or find out its composition. I need to dig it out and find out how it was supposed by the manufacturer !!! what the author wanted to say))))) there are also residents of other, civilized countries, so I think that other drugs are packaged this way, with some thought and purpose, and there is a solution. I am looking for him.

Anonymous

25.10.2021 08:07

American drug it is not so easy for an adult to get it, an analogue of a can of pills with a safe lid from children. Excedrin will run out in the pharmacy, look at the penny askofen – the same pill is absolutely.

Anonymous

10/25/2021 08:10

oh, wow, we had a lot of drugs from America, there has never been such a horror, the antihistamine claritin is obtained with a light wave … and here – just a war every time with a knife and dancing .. Well, at least I made sure that I’m not stupid and there is no easy way, thanks.

Anonymous

25.10.2021 10:58

Saw, but the packaging there is not for those who have a headache without it.

Fluffy 44824 H*

25.