From the Guidelines
For headaches, ibuprofen 400mg every 4-6 hours (not exceeding 1200mg daily) is recommended as a first-line treatment, as it has proven efficacy and a faster onset of action compared to naproxen 1.
Key Considerations
- Ibuprofen works by blocking pain-causing enzymes called COX enzymes and reducing inflammation, with a faster onset of action, typically within 30 minutes 1.
- Naproxen may be considered for longer-lasting relief, but it may have a slightly higher risk of cardiovascular side effects with long-term use 1.
- Both medications can cause stomach irritation, so it is recommended to take them with food 1.
- People with kidney problems, heart conditions, or who take blood thinners should consult a doctor before using either medication 1.
- For severe, persistent, or unusual headaches, seek medical attention rather than continuing to self-medicate 1.
Additional Options
- Other non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and diclofenac potassium may also be effective for acute migraine treatment 1.
- Acetaminophen may be considered for those who are intolerant of NSAIDs, but it has less efficacy 1.
Important Notes
- The 2023 VA/DoD headache guidelines provide a broad scope of recommendations for the management of headache, but they do not provide a specific recommendation for naproxen versus ibuprofen for headaches 1.
- The choice of medication should be individualized based on the patient's medical history, preferences, and values 1.
From the Research
Comparison of Naproxen and Ibuprofen for Headaches
- Both naproxen and ibuprofen are nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used to treat headaches, including migraines 2, 3, 4.
- A study comparing the efficacy of ibuprofen with placebo for acute migraine headaches found that ibuprofen 400 mg was effective in providing pain relief in about half of sufferers, with a number needed to treat (NNT) of 3.2 for 2-hour headache relief 5.
- Another study reviewed the use of combination therapies, including the combination of a triptan and an NSAID, such as sumatriptan and naproxen, which demonstrated better efficacy than using each agent alone 6.
- The 2022 Taiwan Guidelines for Acute Treatment of Migraine recommend oral NSAIDs, including naproxen and ibuprofen, as the first choice for mild to moderate migraine attacks, and suggest that a combination of a triptan and an NSAID may yield better efficacy than either therapy alone 4.
- While there is no direct comparison between naproxen and ibuprofen in the provided studies, the available evidence suggests that both medications can be effective for treating headaches, and the choice between them may depend on individual patient needs and preferences 2, 3, 4.
Efficacy and Safety
- Ibuprofen has been shown to be effective in providing pain relief for acute migraine headaches, with a NNT of 3.2 for 2-hour headache relief 5.
- Naproxen, in combination with sumatriptan, has been shown to be more effective than using either agent alone for acute migraine treatment 6.
- Both naproxen and ibuprofen are generally considered safe and well-tolerated, with similar adverse event profiles 5, 6.
- However, the use of NSAIDs, including naproxen and ibuprofen, should be limited to a maximum of 2 days per week to prevent medication overuse headache 4.