From the Guidelines
Ibuprofen (400-600 mg) and naproxen sodium (500-550 mg) are the most effective NSAIDs for treating migraine attacks, as supported by the latest clinical guideline from the American College of Physicians 1. When it comes to treating migraine attacks, the choice of NSAID should be based on individualized decision making, taking into consideration patient preferences and factors such as route of administration and cost.
- Key points to consider when using NSAIDs for migraine treatment include:
- Taking the medication at the first sign of migraine symptoms for best results
- Using ibuprofen or naproxen sodium as the first-line NSAID options due to their efficacy and relatively favorable side effect profiles
- Considering aspirin (900-1000 mg) as an alternative, although it may cause more gastrointestinal side effects
- Using diclofenac potassium (50-100 mg) for its rapid onset of action
- Taking these medications with food to minimize stomach irritation and staying well-hydrated
- Being aware that individual response to NSAIDs can vary, and trying a different one may be beneficial if the first option doesn't work well
- Using NSAIDs cautiously in patients with kidney problems, stomach ulcers, or heart disease
- Considering combination therapy with anti-nausea medications if needed, especially for patients with severe nausea or vomiting 1. It's essential to note that NSAIDs are most effective for mild to moderate migraines, and if migraines are frequent or severe, consulting a healthcare provider about preventive treatments rather than relying solely on NSAIDs is recommended 1.
From the Research
Effective NSAIDs for Migraine Attacks
- 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 2, 3.
- Naproxen is statistically superior to placebo in the treatment of acute migraine, but the number needed to treat (NNT) of 11 for pain-free response at two hours suggests that it is not a clinically useful treatment 4.
- Other NSAIDs such as diclofenac, mefenamic acid, ketoprofen, tolfenamic acid, and pirprofen have been shown to be effective in some studies, but the effects are marginal in some studies or even without clinical relevance 5.
Dosing of NSAIDs for Migraine Attacks
- Ibuprofen 400 mg is significantly better than 200 mg for 2-hour headache relief, with NNTs for 2-hour pain-free and 2-hour headache relief of 7.2 and 3.2, respectively 2, 3.
- Soluble formulations of ibuprofen 400 mg are better than standard tablets for 1-hour, but not 2-hour headache relief 2, 3.
- Naproxen 500 mg and 825 mg are effective for pain-free response and headache relief, with NNTs for pain-free response and headache relief at two hours of 11 and 6.0, respectively 4.
- The combination of a triptan (such as sumatriptan) with an NSAID (such as naproxen) has demonstrated better efficacy than the use of each agent alone, with improved 2-hour and 24-hour benefits 6.