Is Advil or Tylenol better for a headache?

If you’re like most people, you probably have a medicine cabinet full of over-the-counter pain relief options: Advil (ibuprofen), Tylenol (acetaminophen), or Aleve (naproxen). You might turn to Tylenol for a fever and Advil or Aleve for arthritis pain. But what about when a headache strikes? Is one of these painkillers superior to the other?

“Even though Advil and Tylenol are two of the most common OTC [over-the-counter] pain medications, many people don’t know that they work differently and have different safety concerns,” explains Ashley Wong, Pharm.D., a member of the SingleCare Medical Review Board.

Tylenol and Advil have different mechanisms of action to induce pain relief. “Tylenol works as an analgesic, meaning it relieves pain felt attributed to the nervous system,” says Calvin Anderson, Pharm.D., a therapy care pharmacist for Soleo Health in Tempe, Arizona. “It has both pain relieving and heat relieving [or fever-reducing] properties.”

Ibuprofen and naproxen, however, are nonsteroidal anti-inflammatory drugs or NSAIDs. “Advil works to reduce inflammation throughout the body, which in turn minimizes aches and pains associated with swelling or inflammation,” Dr. Anderson says. So, which one is best for headaches?

Is Tylenol or Advil better for headaches?

When managing headaches, Tylenol stands out as the pain reliever of choice for its efficacy and safety profile, particularly for tension headaches, the most common type of headache. Studies have demonstrated acetaminophen’s ability to effectively reduce pain, highlighting that a big advantage it holds lies in its lower risk of gastrointestinal side effects compared to NSAIDs like ibuprofen. This makes acetaminophen (known as paracetamol outside the U.S.) a preferred choice for individuals with stomach sensitivities or a history of ulcers.

Advil, on the other hand, exerts certain anti-inflammatory effects, which come in handy when treating sinus headaches where inflammation is the primary concern. Advil is also often the painkiller of choice for other pain conditions associated with inflammation, such as muscle aches and menstrual cramps. Ibuprofen, when taken at a high dose of 400 mg every eight hours, has also been consistently shown to trump acetaminophen in the management of different pain conditions, including muscle contraction headaches.

“Choosing between Tylenol or Advil is often a personal choice for those who have headaches,” Dr. Wong says. “Both can help with headache pain, so you may want to choose based on your medical history.” 

Read on to learn more about the potential risks of each medication.

Risks of taking Tylenol or Advil

Like any other medicine, ibuprofen and acetaminophen come with their own list of potential risks, particularly for individuals who have pre-existing medical conditions and pregnant women. It is vital to follow your healthcare provider’s medical advice when it comes to taking these medicines and make sure you take only the recommended dosage.

Tylenol risks and side effects

Tylenol is generally considered safe for most people when taken as directed, even during pregnancy. “Tylenol is typically well tolerated and doesn’t cause many side effects,” Dr. Wong says. However, the active ingredient of this drug is metabolized in the liver, which means that taking exceedingly high doses can lead to liver damage. And due to acetaminophen’s relative safety, it is often within many different OTC and prescription products used for pain relief as well as cough and cold/flu products. So if you’re taking one product for a headache and another for a cold, check to see if both contain acetaminophen and keep overall doses below the daily limits discussed below to avoid liver damage. 

“When taken in large quantities (greater than 4,000 mg in 24 hours), Tylenol is dangerous and will overwhelm your liver’s ability to break down the medication,” Dr. Anderson says. Individuals with pre-existing liver conditions or those who are taking medicines with a narrow effective dose range that are also metabolized in the liver should err on the side of caution when taking acetaminophen, particularly for chronic pain conditions.

Advil risks and side effects

As an NSAID, Advil is known to have side effects on the gastrointestinal system and is not considered safe for use during pregnancy as it may affect fetal organ development. “Advil may cause stomach upset, so it’s best to take it with food,” Dr. Wong says. Using Advil regularly or for prolonged periods of time can lead to inflammation, ulcers, and even bleeding in the stomach.

However, Advil can also affect your kidneys. In individuals with pre-existing kidney disease or those taking other medicines that can also affect the kidneys, taking Advil can aggravate problems and lead to severe kidney damage.

Lastly, all NSAIDs have the potential to increase the risk of a cardiovascular event, such as a heart attack. This occurs because of the way NSAIDs work. Advil belongs to a group of medicines that exert pain relief by blocking the production of cyclo-oxygenase 2, an enzyme that plays an important role in the synthesis of prostaglandins (hormone-like substances). This can affect blood clotting and lead to heart problems. 

Because Advil has some potentially serious side effects, your healthcare provider may recommend checking your blood pressure and kidney function before beginning long-term treatment with this medication.

How to use Tylenol or Advil safely for headaches

When using Tylenol and Advil, following proper dosage guidelines is crucial for safety.

For Tylenol, the maximum daily dose for a healthy adult is typically 4,000 mg. However, to minimize liver risk, it is advisable to limit intake to 3,000 mg per day, especially for people with preexisting health conditions. Regular-strength Tylenol contains 325 mg of acetaminophen per tablet, while extra strength has 500 mg per tablet. The maximum for extra-strength Tylenol is six pills per day (3,000 mg/day), not to be taken more often than every six hours. Alcohol consumption should be limited when taking Tylenol, as excessive alcohol can increase the risk of liver damage. It’s also important to check for acetaminophen in other medications, such as prescription and OTC pain relievers or cough and cold/flu products, to avoid exceeding the safe limit.

Advil’s standard dose for adults is one tablet (200 mg) every four to six hours. If necessary, this can be increased to two tablets every six hours, but not exceeding six tablets (1,200 mg) in 24 hours. “People with heart disease, bleeding disorders, and kidney problems should take Advil with caution,” Dr. Wong explains.

Additionally, watch out for combination treatments—like cold and flu formulations. “There are many many products containing either acetaminophen or ibuprofen, so individuals are urged to read each label carefully to ensure they’re not taking more than they need to,” Dr. Anderson says.

What to do if Tylenol or Advil does not relieve headache?

If Tylenol or Advil doesn’t alleviate your headache, there are other strategies and treatments you can consider. 

Alternate Tylenol and Advil. “Since each drug works differently, individuals could take both together or alternate between the two drugs,” Dr. Anderson says. Be sure to follow the dosage guides for each and not exceed the total 24-hour maximums of either.

RELATED: Can you take Tylenol and Motrin together?

Try a different medication. Other OTC options are available, such as Aleve (naproxen) or Excedrin, which combines acetaminophen, aspirin, caffeine, and naproxen into one OTC drug. 

Use natural remedies: Strategies such as relaxation techniques, exercise, stretching, adequate hydration, and proper sleep can be effective for pain relief. 

See a specialist: For frequent headaches, specialized care is recommended. If you’re regularly experiencing pain that isn’t relieved with over-the-counter treatment, it could be a more severe condition, such as migraine. 

“Those with frequent migraines should see a specialist healthcare provider for stronger prescription medications, like sumatriptan, ergotamine, Ubrelvy, and Vyepti intravenous infusions,” Dr. Anderson says. 

Persistent or severe headaches warrant medical consultation to rule out underlying health issues and ensure appropriate treatment.

Bottom line: When in doubt, ask a pharmacist

The choice between whether to use Advil or Tylenol for headaches ultimately depends on your medical history. If you’re still unsure, consult with your pharmacist. For most people, Tylenol is the safest, most effective option for headache pain relief. However, there are certain circumstances when Advil might be preferable, such as for people with liver conditions. Your pharmacist or healthcare provider can guide you on the best choice for you.