Which nonsteroidal anti-inflammatory drug (NSAID) has a faster onset of action for migraine headache relief, ibuprofen or naproxen?

Which NSAID Has the Faster Onset of Action for Migraine Headache

For fastest onset of action in acute migraine, ibuprofen in soluble formulations provides more rapid relief than naproxen, with superior 1-hour headache relief compared to standard tablets, though both NSAIDs are effective first-line options. 1

Onset of Action Comparison

Ibuprofen - Faster Onset

• Soluble formulations of ibuprofen 400 mg demonstrate significantly better 1-hour headache relief compared to standard tablets, making them the fastest-acting NSAID option for migraine 1
• At 2 hours, ibuprofen 400 mg provides headache relief in 57% of patients (versus 25% with placebo), with a number needed to treat (NNT) of 3.2 1
• Ibuprofen 200 mg achieves 52% headache relief at 2 hours (versus 37% with placebo), with an NNT of 6.3 1
• The higher 400 mg dose is significantly more effective than the 200 mg dose for 2-hour headache relief 1

Naproxen - Slower Onset

• Naproxen 500-825 mg provides headache relief in 45% of patients at 2 hours (versus 29% with placebo), with an NNT of 6.0 2
• Naproxen has an NNT of 11 for pain-free response at 2 hours (17% versus 8% with placebo), which is less favorable than ibuprofen 2
• Naproxen is not considered clinically useful as a stand-alone analgesic in acute migraine, as it is effective in fewer than 2 people in 10 2

Clinical Recommendations

First-Line NSAID Selection

• Both ibuprofen and naproxen sodium are recommended as first-line treatment for mild to moderate migraine attacks 3
• For fastest relief, choose soluble ibuprofen 400 mg over naproxen 1
• Standard ibuprofen tablets at 400 mg remain effective, though with slightly delayed onset compared to soluble formulations 1

Important Considerations

• Begin treatment as early as possible during the attack to improve efficacy 3
• Limit acute medication use to no more than twice weekly to prevent medication-overuse headache 3, 4
• Associated symptoms (nausea, photophobia, phonophobia) are reduced within 2 hours with both NSAIDs, though ibuprofen 400 mg shows particular benefit for photophobia (30% improvement) and phonophobia (49% improvement) 1, 5

Combination Therapy for Enhanced Effect

• When NSAIDs alone provide inadequate relief, combination therapy with aspirin, acetaminophen, and caffeine is recommended 3
• Sumatriptan 85 mg plus naproxen 500 mg provides superior efficacy to either agent alone, with an NNT of 3.1 when treating mild pain early 6