Both can relieve headaches. Acetaminophen is gentler on the stomach, while ibuprofen may work better for inflammation. Limit use to avoid rebound headaches.
Ibuprofen
- NSAID that reduces inflammation.
- May work better for migraines and cramps.
- Take with food.
- OTC max 1,200 mg a day.
Acetaminophen
- Gentler on the stomach.
- Safe in pregnancy at recommended doses.
- Max 3,000 to 4,000 mg a day.
Studies
Both work for tension headaches. Ibuprofen worked slightly better in some trials.
Overuse
Using pain relievers more than 2 to 3 days a week can cause rebound headaches.
Study findings
A 2017 review by Cochrane Library on acute migraine found that ibuprofen 400 mg gave pain-free results at 2 hours in about 23 percent of patients, compared with 11 percent on placebo. Acetaminophen 1,000 mg gave pain-free results in about 20 percent compared with 10 percent on placebo. For tension-type headache, both ibuprofen 400 mg and acetaminophen 1,000 mg work, with ibuprofen having a small edge in some trials.
- Ibuprofen is an NSAID and can irritate the stomach or affect kidneys and blood pressure.
- Acetaminophen is gentler on the stomach but can damage the liver in overdose. The adult maximum is typically 3,000 to 4,000 mg per day on the label.
- Combination with caffeine (as in Excedrin) improves relief by roughly 5 to 10 percentage points in trials.
Overuse warning
Taking pain relievers 15 or more days per month for simple analgesics (or 10 days for combination products) can cause medication overuse headache. Seek care for a worst headache of life, fever with stiff neck, neurological signs or headaches after age 50. People with kidney disease, ulcers or on blood thinners should avoid NSAIDs without advice.
Study findings
A 2017 Cochrane review and other trials found ibuprofen 400 mg is effective for tension type headache and migraine in many people, helping about 1 in 2 within two hours for tension headache. Acetaminophen 1,000 mg is effective for tension headaches in a smaller share. For migraine, ibuprofen generally outperforms acetaminophen.
Overuse warning
Using pain relievers more than 10 to 15 days a month can cause medication overuse headache. Ibuprofen can irritate the stomach and affect kidneys, while excess acetaminophen can harm the liver; the daily maximum is 3,000 to 4,000 mg for adults. Follow the label.
Trial data
A Cochrane review found ibuprofen 400 mg gave pain relief at 2 hours in about 24 percent of tension headache patients compared with 10 percent for placebo, and acetaminophen 1,000 mg gave 25 to 30 percent relief in some trials. For migraine, ibuprofen 400 mg yields pain freedom at 2 hours in about 1 in 4 patients. Combination of acetaminophen, aspirin and caffeine (Excedrin) is effective for migraine.
Safety differences
Ibuprofen can cause stomach upset and raise blood pressure; avoid it in late pregnancy, kidney disease and with some heart conditions. Acetaminophen is easier on the stomach but overdose causes liver failure and is the leading cause of acute liver failure in the US. Adults should not exceed 4,000 mg in 24 hours, ideally 3,000 mg. Avoid combining multiple products containing acetaminophen.
Based on data from the Cochrane Library and the American Migraine Foundation
