People suffering from migraines are paying a hefty price to get Excedrin through online sites nearly seven months after the maker recalled the over-the-counter medication.
On Friday, a package of 50 two-tablet packs of Excedrin Extra Strength was going for $144.95 on Amazon.com, and a similar package of Excedrin Migraine was selling for $245.99. Before the recall, a package cost about $8.
Excedrin, the popular pain medication that thousands take to treat migraines, has been off the market since January, when its maker, Novartis Consumer Health, pulled it from shelves and stopped manufacturing.
Dr. David Dodick of the Mayo Clinic Arizona, who is president of the American Headache Society, called the recall "a big deal for those who rely on that medication."
Many patients claim nothing else works for them. Novartis has said no adverse effects have been reported from patients who did not return the recalled product.
Molly Alexander of Goodyear, Ariz., said that while she relies on more sophisticated treatment for her migraines, her son uses Excedrin Migraine, a combination of 250 milligrams of aspirin, 250 milligrams of acetominophen (Tylenol is a popular brand) and 65 milligrams of caffeine.
"He says it is the only thing that works for him," she said. "His attacks come on quickly, he is throwing up and in bed, he completely loses his functioning."
The doctors agree that over-the-counter medications like Excedrin work only for mild to moderate migraine attacks, and that buying the product from Internet providers can be risky.
"I would never buy off the Internet," Alexander said. "It could be contaminated, and you have no guarantee of what you are getting."
Novartis recalled Excedrin in several forms as well three other popular medications, No-Doz, Bufferin and Gas-X.
Several other products were affected by a shutdown of the plant in Lincoln, Neb., including Maalox and Lamisil.
Michelle Tennis, a trade magazine editor, said she turned to generics after Excedrin disappeared.
"Yesterday, for the first time, it didn't help," said Tennis, adding that she had to leave work and ended up getting relief after taking four pills. "With the Excedrin, one pill took care of everything."
Dr. Alex Bigham, who runs Novocur pain-management clinics in Chandler and Scottsdale, Ariz., said Excedrin seems to be the most effective over-the-counter medication for migraines and patients tell him that generic equivalents or separate pills in the same dosage do not work.
"There is something about how they put it together than makes it different," he said.
Mayo's Dodick said substitutes should work.
"That particular product (Excedrin) has never been proven to be better than separate pills with the same medications and dosages," he said.
The company said in January the pill products "may contain stray tablets, capsules, or caplets from other products, or contain broken or chipped tablets."
A recent statement from Novartis read, "We are working hard to return products to store shelves as soon as possible. Novartis Consumer Health will restart production on a line-by-line, product-by-product basis to ensure control and adherence to our high standard of quality and expects to begin shipments of a limited portfolio of products in the second half of the year."
Both doctors say other treatments are available for migraines, which affect almost 20% of the population.
Dodick said the numbers might even be higher.
"Almost all people who think they have migraines do have them," he said. "And 90% of people who have chronic headaches but do not consider them migraines also have them."
"We developed a questionnaire to identify migraine called 'PIN.' 'P' is for photophobia, or extreme sensitivity to light, 'I' is impairment, and 'N' for nausea. If you get all three with the headache, there is a 98% chance of migraine. If you get only two, you still have a 93% chance."
Dodick said prescription medications are available that can be delivered orally, nasally, through an inhaler, by an injection and now even with a patch.
Doctors are getting closer to developing a blood test for migraines, which will make diagnosis much easier.