It's going to be a tough day at the office and you can just feel the tension brewing in your head, so you pop two Excedrin Migraine. Later that same evening, your kids are driving you up a wall and your head pain starts to kick in again, so your grab two more tablets to nip it in the bud.
Sound familiar? If you're prone to headaches, including debilitating migraine headaches, you are probably familiar with — and may have even grown to rely on — pain relievers like Excedrin to ease your headache pain. But just how much is too much?
Excedrin contains three ingredients that work together: acetaminophen, aspirin and caffeine, explains Brian M. Grosberg, MD, director of the Headache Center at Hartford HealthCare's Ayer Neuroscience Institute in West Hartford, Conn. "Aspirin and acetaminophen both have pain-relieving properties, and caffeine is added to help them work more efficiently," he says.
Both Excedrin Migraine and Excedrin Extra Strength contain 250 milligrams of acetaminophen, 250 milligrams of aspirin and 65 milligrams of caffeine, according to the brand's website. Here are five risks of taking too much of these drugs, alone or together.
Excedrin Overdose Risk No. 1: Liver Damage
Over time, doses of acetaminophen that exceed the recommended dose can lead to liver damage, says the U.S. National Library of Medicine (NLM). This painkiller is found in many over-the-counter and prescription products, often in combination with other drugs, to treat a laundry list of symptoms and conditions, including allergy, colds and the flu. If you aren't aware of all the ingredients in all of your other medications, you can inadvertently end up taking too much acetaminophen at the expense of your liver.
Follow your doctor's instructions, read labels and never take more than the label limit. Even a bit too much acetaminophen can lead to liver damage, the U.S. Food and Drug Administration warns. At first, liver damage causes only vague symptoms, such as nausea and flu-like malaise, so it's easy to miss but can develop into liver failure or death.
Read more: Just What's in Excedrin Migraine?
Excedrin Overdose Risk No. 2: Kidney Damage
Aspirin can be dangerous to your kidneys in too-high doses, Dr. Grosberg says. The National Kidney Foundation points out that regular use of aspirin doesn't cause kidney disease in healthy individuals, but taking large doses — such as more than six or eight tablets a day — may reduce kidney function. If you have kidney disease, ask your doctor what pain medications are safest for you.
How can you tell if your Excedrin use has harmed your kidneys? Your doctor can run simple blood tests, such as a serum creatinine test, to see how well your kidneys are functioning, the foundation says.
Excedrin Overdose Risk No. 3: Intestinal Bleeding
Aspirin is also a blood thinner, the NLM points out, which is why some people take low-dose aspirin daily to lower their risk for a heart attack. It prevents sticky platelets from clumping together in your blood and forming a clot that can block blood flow, causing a heart attack.
That said, aspirin can upset your stomach, cause damage to the lining of the stomach or cause gastrointestinal bleeding, says NLM. Your best bet is to discuss the risks and benefits of aspirin use with your doctor.
Read more: 8 Surprising Things Giving You a Headache
Excedrin Overdose Risk No. 4: The Jitters
You know that jittery, nervous feeling you get when you've had one cup of coffee too many (or maybe more than one)? Well, too much Excedrin means too much caffeine, especially if you're also eating or drinking foods that contain caffeine.
You also may have a lot of trouble falling sleep if you have too much caffeine, and sleep loss can be a migraine trigger, Dr. Grosberg says.
Excedrin Overdose Risk No. 5: Rebound Headache
When you overdo it on headache remedies for a prolonged period of time, you can develop medication-overuse or rebound headaches, Grosberg says. "Most people who use Excedrin take one or two tablets and then, if they need to re-dose later, they will take another one or two," he says. "The concern is not so much this type of redosing on an as-needed basis as it is using this type of medicine in a regular fashion for an extended period of time."
It's hard to say how much Excedrin is too much for any individual, but talking to your doctor and paying attention to ingredients, quantities and dosing instructions can make sure you treat your headaches as safely as possible.