From the Guidelines
Ibuprofen (400-600 mg) and naproxen sodium (500-550 mg) are the most effective NSAIDs for treating migraine attacks, and should be taken at the first sign of migraine symptoms for best results. According to the American College of Physicians guideline 1, the choice of a specific NSAID, such as aspirin, celecoxib, diclofenac, ibuprofen, or naproxen, should be based on individualized decision making, taking into consideration patient preferences.
- Key considerations for NSAID use in migraine treatment include:
- Starting treatment as soon as possible after migraine onset
- Using combination therapy, such as a triptan with an NSAID or acetaminophen, to improve efficacy
- Limiting NSAID use to 2-3 days per week to prevent medication overuse headaches
- Avoiding opioids or butalbital for the treatment of acute episodic migraine
- For maximum effectiveness, NSAIDs should be taken with food to minimize stomach irritation, and consider combining them with an anti-nausea medication if nausea is present, as this can improve absorption 1.
- People with kidney problems, heart disease, or a history of stomach ulcers should use NSAIDs cautiously or avoid them altogether, and consult a healthcare provider about alternative treatment options.
- If NSAIDs alone don't provide adequate relief, consult a healthcare provider about combination therapies or migraine-specific medications like triptans.
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.