BACKGROUND: This is an updated version of the original review published in Issue 10, 2010 (Rabbie 2010). Migraine is a common, disabling condition and a burden for the individual, health services and society. Many sufferers do not seek professional help, relying instead on over-the-counter analgesics. Co-therapy with an antiemetic should help to reduce symptoms commonly associated with migraine headaches. OBJECTIVES: To determine efficacy and tolerability of ibuprofen, alone or in combination with an antiemetic, compared to placebo and other active interventions in the treatment of acute migraine headaches in adults. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Oxford Pain Relief Database, ClinicalTrials.gov, and reference lists for studies through 22 April 2010 for the original review and to 14 February 2013 for the update. SELECTION CRITERIA: We included randomised, double-blind, placebo- or active-controlled studies using self-administered ibuprofen to treat a migraine headache episode, with at least 10 participants per treatment arm. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk and number needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment. MAIN RESULTS: No new studies were found for this update. Nine included studies (4373 participants, 5223 attacks) compared ibuprofen with placebo or other active comparators; none combined ibuprofen with a self-administered antiemetic. All studies treated attacks with single doses of medication. For ibuprofen 400 mg versus placebo, NNTs for 2-hour pain-free (26% versus 12% with placebo), 2-hour headache relief (57% versus 25%) and 24-hour sustained headache relief (45% versus 19%) were 7.2, 3.2 and 4.0, respectively. For ibuprofen 200 mg versus placebo, NNTs for 2-hour pain-free (20% versus 10%) and 2-hour headache relief (52% versus 37%) were 9.7 and 6.3, respectively. The higher dose was significantly better than the lower dose for 2-hour headache relief. Soluble formulations of ibuprofen 400 mg were better than standard tablets for 1-hour, but not 2-hour headache relief.Similar numbers of participants experienced adverse events, which were mostly mild and transient, with ibuprofen and placebo.Ibuprofen 400 mg did not differ from rofecoxib 25 mg for 2-hour headache relief or 24-hour headache relief. AUTHORS' CONCLUSIONS: We found no new studies since the last version of this review. Ibuprofen is an effective treatment for acute migraine headaches, providing pain relief in about half of sufferers, but complete relief from pain and associated symptoms for only a minority. NNTs for all efficacy outcomes were better with 400 mg than 200 mg in comparisons with placebo, and soluble formulations provided more rapid relief. Adverse events were mostly mild and transient, occurring at the same rate as with placebo.
ACHTERGROND steroïdale ontstekingswerende geneesmiddelen, zoals aspirine en ibuprofen is aangetoond dat ze effectief in de behandeling van migraine.
Doel van de effectiviteit van een lage dosis ibuprofen voor de behandeling van acute migraine-aanval te evalueren.
Methoden klinische studies werden geïdentificeerd door middel van elektronische zoekopdrachten (MEDLINE, EMBASE, EBM review, en de Cochrane Library) tot november 2006 en historische zoekopdrachten van relevante artikelen. Studies werden opgenomen wanneer zij (1) waren dubbelblinde, gerandomiseerde, placebo-gecontroleerde studies die geëvalueerd ibuprofen tabletten in matige of ernstige migraine-aanvallen bij patiënten ouder dan 16 jaar, (2) ten minste een migraine-aanval geëvalueerd, en ( 3) gemeld hoofdpijn te verlichten, pijn-vrij, aanhoudende pijn-vrij, of verlichting van andere migraine-geassocieerde symptomen op 2 uur. De MeSH gebruikte zoektermen waren migraine stoornissen, hoofdpijn, vasculaire hoofdpijn, ibuprofen, volwassen, en klinisch onderzoek. Dit werd gevolgd door een trefwoord Zoek met behulp van migraine, hoofdpijn, en cephalgia als sleutelwoorden. De referentielijsten van relevante artikelen werden ook gescand op mogelijke gepubliceerde studies te identificeren. Er was geen taalbeperking. Twee auteurs opgehaalde gegevens onafhankelijk van elkaar. Meningsverschillen werden opgelost door middel van discussie.
RESULTATEN: Ibuprofen 200 en 400 mg effectiever waren dan placebo in het verminderen van pijn intensiteit en het elimineren van pijn (pijn-vrij) binnen 2 uur bij volwassenen met een matige of ernstige migraine-aanvallen. Voor de 200 mg, het aantal te behandelen was 8 (95% CI 5 20) om hoofdpijn te verlichten en 13 (95% CI 8 tot 50) pijnloos. Het risico ratio's om hoofdpijn te verlichten en pijn-vrij waren 1,89 (95% BI 1,45 tot 2,46, p <0,0001) en 2,15 (95% BI 1,24 tot 3,73, p = 0,0063), respectievelijk voor ibuprofen 400 mg. De 24-uurs aanhoudende pijn-vrij resultaat met ibuprofen was niet beter dan met placebo. 400 mg Ibuprofen verhoogde kans op reliëf fotofobie en fonofobie 30% (95% CI 8-57, p <0,01) en 49% (95% CI 23 tot 81, p <0,0001), respectievelijk.
CONCLUSIES: De beschikbare gegevens blijkt dat ibuprofen 200 en 400 mg zijn effectief in het verminderen van hoofdpijn intensiteit en rendering patiënten pijnvrij na 2 uur. Fotofobie en fonofobie verbeterd met 400 mg dosering. Door de beperkte gegevens en de tekortkomingen van de beschikbare gegevens, is verder onderzoek nodig is.
This is an updated version of the original review published in Issue 10, 2010 (Rabbie 2010). Migraine is a common, disabling condition and a burden for the individual, health services and society. Many sufferers do not seek professional help, relying instead on over-the-counter analgesics. Co-therapy with an antiemetic should help to reduce symptoms commonly associated with migraine headaches.
OBJECTIVES:
To determine efficacy and tolerability of ibuprofen, alone or in combination with an antiemetic, compared to placebo and other active interventions in the treatment of acute migraine headaches in adults.
SEARCH METHODS:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Oxford Pain Relief Database, ClinicalTrials.gov, and reference lists for studies through 22 April 2010 for the original review and to 14 February 2013 for the update.
SELECTION CRITERIA:
We included randomised, double-blind, placebo- or active-controlled studies using self-administered ibuprofen to treat a migraine headache episode, with at least 10 participants per treatment arm.
DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed trial quality and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk and number needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment.
MAIN RESULTS:
No new studies were found for this update. Nine included studies (4373 participants, 5223 attacks) compared ibuprofen with placebo or other active comparators; none combined ibuprofen with a self-administered antiemetic. All studies treated attacks with single doses of medication. For ibuprofen 400 mg versus placebo, NNTs for 2-hour pain-free (26% versus 12% with placebo), 2-hour headache relief (57% versus 25%) and 24-hour sustained headache relief (45% versus 19%) were 7.2, 3.2 and 4.0, respectively. For ibuprofen 200 mg versus placebo, NNTs for 2-hour pain-free (20% versus 10%) and 2-hour headache relief (52% versus 37%) were 9.7 and 6.3, respectively. The higher dose was significantly better than the lower dose for 2-hour headache relief. Soluble formulations of ibuprofen 400 mg were better than standard tablets for 1-hour, but not 2-hour headache relief.Similar numbers of participants experienced adverse events, which were mostly mild and transient, with ibuprofen and placebo.Ibuprofen 400 mg did not differ from rofecoxib 25 mg for 2-hour headache relief or 24-hour headache relief.
AUTHORS' CONCLUSIONS:
We found no new studies since the last version of this review. Ibuprofen is an effective treatment for acute migraine headaches, providing pain relief in about half of sufferers, but complete relief from pain and associated symptoms for only a minority. NNTs for all efficacy outcomes were better with 400 mg than 200 mg in comparisons with placebo, and soluble formulations provided more rapid relief. Adverse events were mostly mild and transient, occurring at the same rate as with placebo.
