What is the role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in the treatment of migraines?

From the Guidelines

NSAIDs are the recommended first-line treatment for mild to moderate migraines, with ibuprofen, naproxen sodium, aspirin, or diclofenac potassium being effective options. According to the most recent and highest quality study 1, NSAIDs are effective for treating acute episodic migraine headache in outpatient settings. The study suggests that the choice of a specific NSAID should be based on individualized decision making, taking into consideration patient preferences on such factors as route of administration and cost.

Key Points to Consider

• NSAIDs work best when taken early in an attack and should be limited to 2-3 days per week to avoid medication overuse headaches 1.
• For improved effectiveness, take NSAIDs with food to reduce stomach irritation and consider combining with caffeine (a cup of coffee or tea), which can enhance absorption and effectiveness.
• If one NSAID doesn't work well, try another type as individual responses vary.
• People with kidney disease, heart disease, stomach ulcers, or who are pregnant should consult a healthcare provider before using NSAIDs for migraines.

Additional Considerations

• The study also recommends considering the use of triptans, ergot alkaloids, or CGRP antagonists for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to NSAIDs or acetaminophen 1.
• Preventive treatments should be considered for those with frequent migraines, rather than relying solely on NSAIDs.
• Patients should be aware of medication overuse headache, which is a potential complication of migraine treatment, and should be counseled to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy 1.

From the Research

NSAIDs for Migraines

• NSAIDs are considered a first-line treatment for mild to moderate migraines 2, 3, 4
• Examples of NSAIDs used to treat migraines include ibuprofen, naproxen sodium, diclofenac potassium, and acetylsalicylic acid 3
• Ibuprofen has been shown to be effective in reducing pain intensity and eliminating pain within 2 hours in adults with moderate or severe migraine attacks 5, 6
• The efficacy of ibuprofen is dose-dependent, with 400 mg being more effective than 200 mg for 2-hour headache relief 5, 6

Treatment Strategies

• The acetaminophen-NSAID strategy is suitable for patients with attacks of mild to moderate severity 3, 4
• The triptan strategy is suitable for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs 3, 4
• Combination therapy with a triptan and an NSAID may be more effective than either therapy alone 4

Safety and Efficacy

• NSAIDs are generally well-tolerated, with mild and transient adverse events 5
• Ibuprofen has been shown to reduce associated symptoms of nausea, vomiting, photophobia, and phonophobia, as well as functional disability 5
• Acetaminophen is considered the safest acute migraine drug during pregnancy, and ibuprofen may be an option for selected patients 3, 4