Is naproxen (nonsteroidal anti-inflammatory drug (NSAID)) effective and safe for headache treatment?

Naproxen for Headache Treatment

Naproxen is an effective treatment option for mild to moderate headaches, particularly tension-type headaches, and can be used as part of combination therapy for migraines, though it is not recommended as a standalone treatment for acute migraines.

Efficacy for Different Headache Types

Tension-Type Headaches

• Naproxen (275-550 mg) is recommended for the short-term treatment of tension-type headaches 1
• Studies show naproxen 375 mg is significantly superior to placebo for tension-type headache relief 2
• Recommended dosage: 275-550 mg every 2-6 hours with a maximum daily dose of 1.5g 3

Migraine Headaches

• Naproxen alone is not clinically useful as a standalone treatment for acute migraine, with an NNT of 11 for pain-free response at two hours 4
• More effective when used in combination with other medications:
  • The combination of sumatriptan and naproxen is strongly recommended for short-term migraine treatment 1
  • For patients with contraindications to triptans, adding naproxen to acetaminophen is suggested 3

Administration and Dosing

Recommended Dosing

• For tension-type headaches: 275-550 mg every 2-6 hours (maximum 1.5g daily) 3
• For migraine (as part of combination therapy): 500 mg 3
• Begin treatment as soon as possible after headache onset 3
• Limit use to fewer than 15 days per month to avoid medication overuse headache 3

Special Considerations

• For menstrual migraine: Long-acting naproxen can be used as perimenstrual preventive treatment, beginning 2 days before expected menstruation for 5 days 1
• For mild to moderate migraine attacks: NSAIDs including naproxen are suggested as first-line options 1

Safety and Adverse Effects

Common Adverse Effects

• Gastrointestinal effects: heartburn, abdominal pain, nausea, dyspepsia 5
• Central nervous system effects: headache, dizziness, drowsiness 5
• Dermatologic effects: pruritus, skin eruptions 5

Precautions

• Gastrointestinal reactions are more frequent and severe at higher doses (1500 mg vs 750 mg daily) 5
• Avoid in patients with:
  • History of GI bleeding or ulcers
  • Severe renal impairment
  • Advanced liver disease
  • Heart failure

Treatment Algorithm

1. For tension-type headaches:

   • Start with naproxen 550 mg
   • May repeat dose after 2-6 hours if needed (maximum 1.5g daily)
   • If inadequate response, consider adding acetaminophen

2. For migraine headaches:

   • For mild attacks: Start with naproxen 500 mg
   • For moderate to severe attacks: Use combination therapy (naproxen + triptan)
   • If triptans are contraindicated: Consider naproxen + acetaminophen

3. For menstrual migraine prevention:

   • Begin naproxen 500 mg daily, starting 2 days before expected menstruation
   • Continue for 5 days total

4. Monitoring:

   • Limit use to fewer than 15 days per month
   • Watch for GI symptoms and discontinue if severe
   • Consider prophylactic treatment if headaches occur frequently (≥2/month)

Comparative Efficacy

• For tension-type headaches: Naproxen 375 mg is comparable to acetaminophen 1000 mg 2
• For migraines: Combination of sumatriptan-naproxen is more effective than naproxen alone 6, 7
• Early intervention with naproxen (treating when pain is mild) may help reduce headache frequency over time 7

Remember that while naproxen is effective for tension-type headaches, it should primarily be used as part of combination therapy for migraines rather than as monotherapy, as evidence shows limited efficacy when used alone for migraine attacks.