Paracetamol versus ibuprofen in treating episodic tension-type headache: a systematic review and network meta-analysis

Abstract

Tension-type headache (TTH) is the most common type of headache worldwide. It is defined and classified according to the International Classification of Headache Disorders. TTH is treated with over-the-counter medications, mostly paracetamol or ibuprofen. The purpose was to assess the effectiveness of paracetamol versus ibuprofen in treating episodic tension-type headache (ETTH) through direct and indirect comparisons of randomized controlled trials (RCTs). We included RCTs comparing paracetamol with a placebo, ibuprofen with a placebo, or paracetamol with ibuprofen for acute ETTH treatment that were published between 1988 and 2022. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and the Web of Science. The Cochrane Collaboration risk of bias tool was used to assess the risk of bias. We identified 14 studies including 6521 people with ETTH. None of the studies had a low risk of bias for all domains; this was most likely due to inadequate reporting and a small sample size. Ibuprofen (odds ratio (OR): 1.73, 95% confidence interval (CI): 1.17–2.56) showed better efficacy than paracetamol (OR: 1.62, 95% CI 1.24–2.13) for pain-free status at 2 h, while paracetamol (OR: 1.42, 95% CI 0.87–2.30) showed better efficacy than ibuprofen (OR: 1.20, 95% CI 0.58–2.48) for pain-free status at 1 h. Paracetamol was associated with the lowest likelihood of rescue medication use (OR: 0.49, 95% CI 0.37–0.65). Ibuprofen was associated with a lower likelihood of the occurrence of any events and gastrointestinal adverse events compared with placebo and paracetamol (OR: 0.95, 95% CI 0.64–1.41 and OR: 0.81, 95% CI 0.44–1.50, respectively). Paracetamol and ibuprofen showed better efficacy than placebo in treating ETTH; there was no statistically significant difference in efficacy between the two drugs. For individuals at a higher risk (like renal insufficiency or risk of GI bleeding), paracetamol may be considered as a preferred option instead of Ibuprofen. Further meta-analyses of head-to-head trials are needed for direct comparisons in the future.PROSPERO registration number: CRD42022340936.

Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study

“…The treatment of acute TTH episodes using multiple oral non-steroidal anti-inflammatory drugs (NSAIDs) remains the first treatment option, recommended by the European Federation of Neurological Societies Task Force (EFNS-TF). Ibuprofen and ketoprofen, combined with caffeine, have shown the greatest efficacy in the treatment of TTH; this is compared to paracetamol or aspirin, with minimal alterations in the previous safety profile [21]. The preventive treatment of episodes is only recommended for frequent episodic and chronic TTH patients [1,2].…”