-
The Annals of Pharmacotherapy Nov 2007Nonsteroidal antiinflammatory drugs such as aspirin and ibuprofen have been shown to be effective in treating migraine. (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Nonsteroidal antiinflammatory drugs such as aspirin and ibuprofen have been shown to be effective in treating migraine.
OBJECTIVE
To evaluate the efficacy of low-dose ibuprofen for treatment of acute migraine attack.
METHODS
Clinical trials were identified through electronic searches (MEDLINE, EMBASE, EBM review, and the Cochrane Library) up to November 2006 and historical searches of relevant articles. Studies were included if they (1) were double-blind, randomized, placebo-controlled trials that evaluated ibuprofen tablets in moderate or severe migraine attacks in patients greater than 16 years of age, (2) evaluated at least one migraine attack, and (3) reported headache relief, pain-free, sustained pain-free, or relief of other migraine-associated symptoms at 2 hours. The MeSH search terms used were migraine disorders, headache, vascular headache, ibuprofen, adult, and clinical trial. This was followed by a key word search using migraine, cephalalgia, and cephalgia as key words. The reference lists of relevant articles were also scanned to identify possible published trials. There was no language restriction. Two authors extracted data independently. Disagreements were resolved through discussion.
RESULTS
Ibuprofen 200 and 400 mg were more effective than placebo in reducing pain intensity and eliminating pain (pain-free) within 2 hours in adults with moderate or severe migraine attacks. For the 200 mg dose, the number needed to treat was 8 (95% CI 5 to 20) for headache relief and 13 (95% CI 8 to 50) for pain-free. The risk ratios for headache relief and pain-free were 1.89 (95% CI 1.45 to 2.46; p < 0.0001) and 2.15 (95% CI 1.24 to 3.73; p = 0.0063), respectively, for ibuprofen 400 mg. The 24-hour sustained pain-free outcome with ibuprofen was no better than with placebo. Ibuprofen 400 mg increased the chance of relief in photophobia and phonophobia by 30% (95% CI 8 to 57; p < 0.01) and 49% (95% CI 23 to 81; p < 0.0001), respectively.
CONCLUSIONS
The available evidence suggests that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing. Due to the limited data and the shortcomings of the available evidence, further studies are needed.
Topics: Acute Disease; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Ibuprofen; Male; Migraine Disorders; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 17878396
DOI: 10.1345/aph.1K121 -
Journal of Clinical Pharmacy and... Dec 2005To evaluate the efficacy and tolerability of frovatriptan in acute migraine treatment. (Review)
Review
OBJECTIVE
To evaluate the efficacy and tolerability of frovatriptan in acute migraine treatment.
METHODS
Systematic review and meta-analysis of randomized controlled trials. Clinical trials of frovatriptan were systematically identified through electronic searches and historical searches up until February 2005. Studies were included if they were (i) double-blind, randomized, placebo controlled trials that evaluated frovatriptan 2.5 mg in acute migraine treatment and (ii) reporting the efficacy data in terms of pain-free, headache response, headache recurrence, or relief of migraine-associated symptoms. Two authors extracted data independently. Disagreements were resolved through discussion. The efficacy was estimated using risk ratio (RR), risk difference, and number needed to treat together with 95% confidence intervals.
RESULTS
Five trials involving a total of 2,866 patients were included. Frovatriptan 2.5 mg was more effective than placebo in rendering patient pain-free (RR 3.70, 95% CI 2.59-5.29, P < 0.0001 at 2 h and 2.67, 95% CI 2.21-3.22, P < 0.0001 at 4 h post-dose). It was also superior to placebo in reducing headache severity. The pooled RR was 1.66 (95% CI 1.48-1.88, P < 0.0001) and 1.83 (95% CI 1.66-2.00, P < 0.0001), respectively, at 2 and 4 h after treatment. In those whose headache was relieved at 4 h, the risk of headache recurrence within 24 h was reduced by 26% with frovatriptan (RR 0.74, 95% CI 0.59-0.93, P = 0.009). Frovatriptan was also superior to placebo in improving symptoms associated with migraine. At 2 h after dosing, frovatriptan reduced the risk of nausea by 14% (95% CI 6-20%, P = 0.0005), photophobia 17% (95% CI 12-22%, P < 0.0001), and phonophobia 14% (95% CI 17-20%, P < 0.0001). The corresponding numbers at 4 h after dosing were 37% (95% CI 30-43%, P < 0.0001), 34% (95% CI 29-39%, P < 0.0001) and 30% (95% CI 23-36%, P < 0.0001), respectively. Frovatriptan caused more adverse events than did placebo (RR 1.31, 95% CI 1.07-1.62, P = 0.01).
CONCLUSION
The available evidence suggests that frovatriptan is more effective but may cause more adverse events than placebo in the treatment of acute moderate to severe migraine. It is effective in providing pain relief and reducing the risk of recurrence. However, its effectiveness relative to other more established agents needs to be better defined by appropriate head to head trials.
Topics: Carbazoles; Double-Blind Method; Humans; Meta-Analysis as Topic; Migraine Disorders; Randomized Controlled Trials as Topic; Treatment Outcome; Tryptamines
PubMed: 16336284
DOI: 10.1111/j.1365-2710.2005.00677.x