Ibuprofen with or without an antiemetic for acute migraine headaches in adults

Abstract

Background Migraine is a common, disabling condition and a burden for the individual, health services and society. Many sufferers do not seek professional help, relying instead on over-the-counter analgesics. Co-therapy with an antiemetic should help to reduce symptoms commonly associated with migraine headaches. Objectives To determine efficacy and tolerability of ibuprofen, alone or in combination with an antiemetic, compared to placebo and other active interventions in the treatment of acute migraine headaches in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies through 22 April 2010. Selection criteria We included randomised, double-blind, placebo- or active-controlled studies using self-administered ibuprofen to treat a migraine headache episode, with at least 10 participants per treatment arm. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk and number needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment. Main results Nine studies (4373 participants, 5223 attacks) compared ibuprofen with placebo or other active comparators; none combined ibuprofen with a self-administered antiemetic. All studies treated attacks with single doses of medication. For ibuprofen 400 mg versus placebo, NNTs for 2-hour pain-free (26% versus 12% with placebo), 2-hour headache relief (57% versus 25%) and 24-hour sustained headache relief (45% versus 19%) were 7.2, 3.2 and 4.0, respectively. For ibuprofen 200 mg versus placebo, NNTs for 2-hour pain-free (20% versus 10%) and 2-hour headache relief (52% versus 37%) were 9.7 and 6.3, respectively. The higher dose was significantly better for 2-hour headache relief than the lower dose. Soluble formulations of ibuprofen 400 mg were better than standard tablets for 1-hour, but not 2-hour headache relief. Associated symptoms of nausea, vomiting, photophobia and phonophobia and functional disability were reduced within 2 hours, and fewer participants used rescue medication with ibuprofen compared with placebo. Similar numbers of participants experienced adverse events, which were mostly mild and transient. Ibuprofen 400 mg did not differ from rofecoxib 25 mg for 2-hour headache relief, 24-hour headache relief or use of rescue medication. Authors’ conclusions Ibuprofen is an effective treatment for acute migraine headaches, providing pain relief in about half of sufferers, but complete relief from pain and associated symptoms for only a minority. NNTs for all efficacy outcomes were better with 400 mg than 200 mg in comparisons with placebo, and soluble formulations provided more rapid relief. Adverse events were mostly mild and transient, occurring at the same rate as with placebo.

Evidence for efficacy of acute treatment of episodic tension-type headache: Methodological critique of randomised trials for oral treatments

“…The lack of evidence on drug treatments of TTH is in contrast to that for migraine: for just one drug, sumatriptan, a Cochrane overview found information on over 50,000 patients in trials examining 18 drug/dose/route of administration combinations [9]. It is true that evidence about commonly available drugs such as paracetamol, aspirin, and ibuprofen also is limited in migraine [10,34,63]. Table 4 compares the available information and efficacy results for paracetamol 1000 mg and ibuprofen 400 mg for 2-hour outcomes.…”

“…Comparison of data available for pooling for various outcomes for TTH and migraine.Data for migraine taken from Derry et al[10] (paracetamol) and Rabbie et al[63] (ibuprofen).…”

Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial

“…A Cochrane meta-analysis showed that oral forms of paracetamol,3 ibuprofen,4 diclofenac5 and sumatriptan, that seem to be more expensive than simple analgesics,6 are effective in treating the migraine attack. However, few studies have examined the effectiveness of parenteral drugs in migraine attacks.…”

Treatment of migraine: update on new therapies

“…Other Cochrane meta-analyses confirmed that ibuprofen (most frequent dose 400 mg) is effective for acute migraine treatment, but patients are seldom pain-free [27], and that aspirin 1000 mg has similar efficacy as sumatriptan [28]. For the management of primary headache recurrence after emergency ward treatment (threefourth of patients, 45% typical migraineurs), naproxen 500 mg was found comparable to sumatriptan 100 mg [29].…”