For many people suffering from migraine headaches, over-the-counter ibuprofen -- Advil and Motrin are well-known brands -- might be enough to relieve the pain.
A new Cochrane review finds that about half of those with migraine headaches will have pain relief within two hours after taking ibuprofen.
"We knew that many migraineurs rely on over-the-counter medication to treat attacks and surveys show that while some find them helpful, many are dissatisfied," said review co-author Sheena Derry of the Pain Research and Nuffield Department of Anaesthetics at the University of Oxford.
Migraine headache is intense throbbing pain on one side of the head, and an attack can last anywhere between four and 72 hours. Symptoms such as nausea, vomiting, aura and increased sensitivity to light and sound often accompany migraines.
The systematic review was published by The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
According to the Migraine Research Foundation, migraine ranks in the top 20 of the world's most disabling medical illnesses with more than 10 percent of the population, including children, suffering from the condition.
Migraine also causes less productivity at work and school. Less than 10 percent of sufferers are able to work or function normally during their migraine attacks, and American employers lose more than $13 billion each year as a result of 113 million lost work days, says the Migraine Research Foundation.
To relieve their headache pain, almost half (49 percent) of migraine sufferers use over-the-counter medication only, 20 percent use prescription medication and 29 percent use both, according to the Cochrane review.
Derry said she and her fellow reviewers conducted the Cochrane review to help provide a more definitive answer on whether ibuprofen is effective for migraine pain. They also wondered whether also taking an antiemetic to relieve nausea was better than taking an ibuprofen alone.
"We knew that there were a number of published trials using ibuprofen for acute treatment of attacks," she said. "Individual trials, however, can be misleading for a number of reasons, and generally it is recognized that using systematic review and meta-analysis is likely to provide a more accurate estimate of the effects of any intervention."
The reviewers evaluated nine studies with 4,373 adult participants who had a diagnosis of migraine headache. The average age of the participants was 30 to 40 years and all had a history of migraine for at least 12 months before entering the studies.
In total, 414 people with migraines underwent treatment with 200 milligrams of ibuprofen, 1,615 received a dose of 400 milligrams, 208 received a 600-milligram dose and 1,127 received a placebo.
Twenty-six percent of patients taking the 400-milligram dose were pain free within two hours, compared with 20 percent who took the smaller dose and 11 percent who received a placebo. In the same period, 57 percent who took 400 milligrams of ibuprofen had their pain reduced from moderate or severe to "no worse than mild," compared with 25 percent taking a placebo.
"For those who experience these outcomes, ibuprofen is a useful, inexpensive and readily available treatment," Derry said. "Those who don't experience good outcomes will need to look at alternative treatments."
Roger Chou, M.D., associate professor of medicine at Oregon Health & Science University and the director of clinical guidelines development at the American Pain Society, said that it is common to use OTC medications such as ibuprofen to treat migraines.
"Migraine sufferers really vary in what they do, in part because the severity and frequency varies so much," said Chou. "People with relatively mild migraines probably do use over-the-counter medications and so do people who find that they work."
He added, "Those with more severe migraines, or who don't get relief with over-the-counter medications, or who have very frequent migraines, often end up in the doctor's office and are given various prescriptions."
Derry and her colleagues also found that the nausea and other symptoms that usually accompany migraines decreased within two hours and fewer participants used rescue medications with ibuprofen compared with placebo. Only mild side effects occurred with the ibuprofen.
The reviewers found little information comparing ibuprofen with other medications and no information comparing the effectiveness of ibuprofen combined with an antiemetic.
Two of the four reviewers disclosed previous consulting work with various pharmaceutical companies.
- Roy Rabbie, Sheena Derry, R Andrew Moore, Henry J McQuay. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews, 2010 (10): CD008039 DOI: 10.1002/14651858.CD008039.pub2
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