A recent study suggests that ibuprofen might not be the optimal choice for treating migraines.
Despite the popularity of certain over-the-counter pain medications, their effectiveness can vary. According to new research published in Neurology last month, migraine-specific drugs were found to be up to five times more effective than commonly used medications like ibuprofen.
The study also highlighted that non-steroidal anti-inflammatory drugs (NSAIDs) other than ibuprofen demonstrated greater efficacy.
Chia-Chun Chiang, MD, the lead author of the study and an assistant professor of neurology and headache specialist at the Mayo Clinic in Rochester, Minnesota, emphasized the importance of consulting a doctor when individuals consistently resort to over-the-counter medications for headache relief. Dr. Chiang stated, “We have many migraine-specific medications that we can try.”
Discover which migraine medications may offer a higher likelihood of alleviating symptoms.
The most effective treatments for migraines include Triptans, Ergots, and Antiemetic Medications.
Chiang and her team conducted an assessment of 25 different types of migraine medications, utilizing a smartphone app for data collection.
Through the app, participants contributed over 4.7 million records detailing the medications used for migraines and their effectiveness. The research team discerned the most effective classes of drugs for migraine treatment and identified specific medications within those classes that proved highly potent against migraine attacks.
The study revealed that three classes of drugs—triptans, ergots, and antiemetic medications—outperformed ibuprofen significantly. Triptans, which bind to serotonin receptors in the brain, including medications like Migranow (sumatriptan), Zomig (zolmitriptan), Frova (frovatriptan), and Relpax (eletriptan), were found to be five times more effective than ibuprofen.
Ergots, comprising ergotamine or dihydroergotamine, sometimes combined with caffeine in drugs like Ergomar (ergotamine), Migranal (dihydroergotamine), and Trudhesa (dihydroergotamine), proved three times more effective than ibuprofen.
Antiemetic medications, addressing nausea and including Reglan (metoclopramide), Compazine (prochlorperazine), and chlorpromazine, were nearly three times more effective than ibuprofen.
Among the individual medications studied, eletriptan, zolmitriptan, and sumatriptan—all triptans—emerged as the most effective.
While ibuprofen exhibited a success rate of approximately 42%, migraine-specific medications, especially triptans, demonstrated efficacy ranging between 72% and 78%. Other NSAIDs, such as ketorolac, indomethacin, and diclofenac, as well as prescription drugs, also surpassed ibuprofen in effectiveness.
Acetaminophen, the active ingredient in Tylenol, was found to be 17% less effective than ibuprofen. Chiang emphasized that the study, utilizing real-world patient-generated data, provides a comprehensive comparison of 25 medications, reinforcing findings from randomized clinical trials.
Migraine Is an Under-Treated Condition
While the recent study provides valuable insights, there are certain gaps in its findings.
The research team gathered data over a six-year period, concluding in 2020. Notably, the Food and Drug Administration (FDA) has since approved several new migraine drugs, including two distinct types: gepants, categorized as calcitonin gene-related peptide (CGRP) inhibitors, and ditans, functioning similarly to triptans.4
An essential consideration is that the study did not account for the dosage of medications, and it excluded the use of any recently approved migraine treatments. This includes the aforementioned gepants and ditans. Dr. Hope O’Brien, founder and medical director of Headache Center of Hope in Cincinnati, Ohio, highlighted this omission, emphasizing the importance of recognizing the absence of specific dosage information and the exclusion of newer migraine treatments.
The study also revealed a significant issue known to headache specialists—migraine is often undertreated. Nearly half of the participants reported inadequate pain relief, with 33% stating the need for multiple medications to manage migraine pain. Dr. O’Brien, a fellow of the American Academy of Neurology and the American Headache Society, emphasized the gravity of this problem.
Furthermore, the study did not differentiate how the medications were administered—whether as a pill, injection, or nasal spray. Dr. Chia-Chun Chiang, the lead author, acknowledged the need for further research to confirm the impact of different dosages and formulations of medications, underscoring the importance of incorporating newer migraine medications in future studies.
Despite these limitations, Dr. Chiang highlighted the groundbreaking aspect of the study, as it departs from traditional data sources by utilizing information on migraine medications directly generated by patients through an online electronic diary. This novel approach offers a unique perspective on understanding the effectiveness of migraine treatments.
Diagnosing Migraine Disorders
Doctors may use migraine diagnostic criteria published by the American Headache Society to diagnose a person with a headache condition.
Migraines are headaches that last between 4 and 72 hours. They also have at least two of these four criteria: unilateral pain, meaning pain on one side of the head, pulsating or throbbing pain, moderate-severe intensity, and pain that’s aggravated by routine physical activity, such as walking around the house.
A migraine also causes at least one of the following: nausea, vomiting, and/or sensitivity to sound and light.
According to the American Headache Society, to have a migraine disorder, people must have at least five attacks in a lifetime.
In the 2021 consensus statement, the American Headache Society recommended a step-up approach to migraine management, meaning patients should start with either a single medication, lower doses, or over-the-counter treatments before building upon that base to pin down an individualized approach that works for them.
“Most patients have already tried over-the-counter medications, so patients who have been identified with migraine should be treated with a migraine-specific medication,” O’Brien said. “The goal is that they use one medication to stop a migraine and they are back to normal within 1–2 hours.”
Some people may require a second medication as a backup.
“But the goal is not to use multiple medications,” O’Brien said.