13 NSAIDs have antiinflammatory analgesic and antipyretic proprieties mediated by blockade of the COX enzymes and subsequent inhibition of prostaglandin synthesis 45 Several overthecounter NSAIDs have demonstrated efficacy in treating headache and migraine ID: 1009988
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1. MigraineAnalgesicsNSAIDs are recommended for the acute treatment of migraine by many guidelines1-3.NSAIDs have anti-inflammatory, analgesic, and anti-pyretic proprieties, mediated by blockade of the COX enzymes, and subsequent inhibition of prostaglandin synthesis4,5.Several over-the-counter NSAIDs have demonstrated efficacy in treating headache and migraine4,6.A meta-analysis of data from 4 RCTs comparing a certain NSAID with placebo showed the NSAID to be superior7A double-blind study of 660 patients with migraine showed that another specific different NSAID was superior to placebo8.A Cochrane analysis of a different NSAID, including 1,356 patients, concluded that use of the NSAID reduced moderate-to-severe pain to no more than mild pain in 55% of those treated9.Other analgesics than NSAIDs are also often recommended, typically if NSAIDs are contraindicated1,2,10.Some over-the-counter analgesics – such as acetaminophen and acetylsalicylic acid – have shown efficacy in treating acute headache6.A Cochrane systematic review including 2,942 participants9 found that acetaminophen was superior to placebo on all outcomes9.Another Cochrane analysis of acetylsalicylic acid data found 52% of patients treated with acetylsalicylic acid experienced pain relief at 2 hours, compared with 32% of those taking placebo11.COX=cyclooxygenase; NSAID=non-steroidal anti-inflammatory drug; RCT=randomised controlled trial1. Marmura et al. Headache 2015;55(1):3–20; 2. Worthington et al. Can J Neurol Sci 2013;40(5 Suppl 3):S1–S80; 3. Eigenbrodt et al. Nat Rev Neurol. 2021; 17(8): 501-514; 4. Pardutz & Schoenen. Pharmaceuticals (Basel) 2010;3(6):1966–1987; 5. Chandrasekharan et al. Proc Natl Acad Sci USA 2002;99(21):13926–13931; 6. Vargas. Continuum (Minneap Minn) 2018;24(4, headache):1032–1051; 7. Suthisisang et al. Headache 2010; 50(5): 808-818; 8. Codispoti et al. Headache 2001; 41(7):665-679; 9. Derry et al. Cochrane Database Syst Rev 2013;(4):CD008783; 10. Steiner et al. J. Headache Pain 2019; 20(1):57; 11. Kirthi et al. Cochrane Database Syst Rev 2013;(4):CD008041Non-steroidal anti-inflammatory drugs(NSAIDs)Other analgesics