'Where Is My Excedrin?'
Headache Sufferers Hang On, With Some Paying Sky-High Prices Online and Others Concocting Their Own Remedies
Generics vs. Excedrin Migraine
"There is not really any reason to believe the formulation of the generic versions are any different than that of Excedrin Migraine," says Andrew Charles, MD, professor of neurology and director of the University of California at Los Angeles Headache Research and Treatment Program.
Many migraine formulas are identical, agrees Allen Vaida, PharmD, executive vice president of the Institute for Safe Medication Practices.
Excedrin Migraine's active ingredients include:
- 250 milligrams of acetaminophen
- 250 milligrams of aspirin
- 65 milligrams of caffeine
Walgreens' Migraine Relief has the exact same ingredients at exactly the same doses.
When looking at Excedrin Migraine and other versions of the same formula, ''we suspect the difference between them to be minimal," says Jason Rosenberg, MD, assistant professor of neurology at Johns Hopkins Medical Institutions and director of the Johns Hopkins Headache Center at Bayview.
If two medicines have the same active ingredients, they are what experts term ''bioequivalent." That means that the ''same amount of the same ingredients get into your blood stream at about the same time," Rosenberg says.
In individual people, he says, ''the drugs might be absorbed differently. But I would be skeptical that it would have much effect."
Keeping steady and specific blood levels is crucial for some drugs, Charles says. However, ''we wouldn't consider migraine or headache in general to be one of those conditions where blood levels [of the medication] would be a big issue."
Explaining the Excedrin Loyalty
So what's going on with the die-hard Excedrin users?
"There is a significant amount of placebo response and patient brand loyalty, based in part on their experience and also on marketing," Charles says.
"Part of the beneficial effect of the drug is the belief that it does work," Rosenberg says.
"The placebo effect is a real effect," Rosenberg says. It can explain as much as 25% to 50% of the benefit of a drug, he says.
He cites research in which less expensive drugs were found to have less of a placebo effect.
Researchers from Massachusetts Institute of Technology and Stanford gave 82 people placebo pills and told them they were for pain relief. Half were told the drugs cost $2.50 a pill; the other half were told the pills were 10 cents each.
The men and women were then given shocks to the wrists. Those taking the higher-price pills reported greater pain reduction.
What a doctor advises a headache patient to take matters, too, Rosenberg says.
If a doctor recommends a specific medicine, the patient's expectations of that drug may be high, he says.
It's not uncommon for patients to say one drug works better than another, even if the formulas are the same, Vaida says. "Someone gets used to a certain medicine," he says. "There is a psychological component to it."
"Patients do become quite attached to specific brands of medicine," Charles says. ''That's true not just of headache but for other sorts of conditions."