Is Benadryl (diphenhydramine) effective for treating headaches?

Benadryl (Diphenhydramine) for Headache Treatment

Benadryl (diphenhydramine) is not recommended as a first-line treatment for headaches, including migraines, as there is insufficient evidence supporting its effectiveness as a standalone therapy for headache relief. 1

Evidence-Based First-Line Treatments for Headaches

Migraine Headaches

1. First-Line Treatments:

   • NSAIDs are the recommended first-line therapy for most migraine attacks 2, 1
     • Ibuprofen (400-800 mg)
     • Naproxen sodium (275-550 mg)
     • Aspirin (650-1000 mg)
     • Tolfenamic acid (not available in US)
   • Acetaminophen-aspirin-caffeine combination 1

2. Second-Line Treatments:

   • Triptans (for migraines not responding to NSAIDs) 2, 1
     • Naratriptan
     • Rizatriptan
     • Sumatriptan
     • Zolmitriptan

Role of Diphenhydramine in Headache Management

Diphenhydramine has limited evidence supporting its use as a primary headache treatment:

1. As Adjunctive Therapy:

   • May be used in combination with other medications in emergency settings 3
   • However, research shows that when added to standard migraine treatments like metoclopramide, diphenhydramine does not significantly improve outcomes 4

2. Research Evidence:

   • A randomized clinical trial found that IV diphenhydramine + metoclopramide did not result in greater rates of sustained headache relief compared to placebo + metoclopramide 4
   • In another study, diphenhydramine was used as part of a combination therapy with trimethobenzamide, but was found less effective than sumatriptan for acute migraine at 2 hours 5

When Diphenhydramine Might Be Considered

Despite not being a first-line treatment, diphenhydramine might be considered in specific situations:

1. For sedation: When headache is preventing sleep
2. For allergic symptoms: When headache is accompanied by allergic manifestations
3. As adjunctive therapy: In emergency settings as part of combination therapy 3

Recommended Approach to Headache Management

1. For mild to moderate headaches:

   • Start with NSAIDs (ibuprofen, naproxen, aspirin) 1, 6
   • Consider acetaminophen-aspirin-caffeine combination 1

2. For moderate to severe migraines:

   • NSAIDs as first-line 2, 1
   • If ineffective, consider triptans 2, 1
   • For migraines with significant nausea/vomiting, use non-oral routes of administration 1

3. For tension-type headaches:

   • NSAIDs and aspirin have demonstrated efficacy 7

Important Considerations and Cautions

• Acetaminophen alone is ineffective for migraine treatment 2, 1
• Limit acute headache treatments to no more than twice weekly to prevent medication overuse headaches 2
• Opioids should be reserved for when other medications cannot be used 2
• Regular use of diphenhydramine for headaches is not supported by evidence and may lead to tolerance and side effects including sedation, dry mouth, and cognitive impairment

Bottom Line

While diphenhydramine (Benadryl) is commonly used for allergic reactions and as a sleep aid, it lacks sufficient evidence as an effective treatment for headaches. NSAIDs remain the evidence-based first-line treatment for most headaches, with triptans as second-line therapy for migraines not responding to NSAIDs.