Ibuprofen for migraine

What ibuprofen is used for

Ibuprofen is an NSAID. The US label of Motrin IB Migraine, a liquid-filled capsule, states one use: “treats migraine”. NICE CG150 lists an NSAID as a single-medicine option for migraine and as a partner to an oral triptan, without naming a specific NSAID.

Ibuprofen is sold in other forms and under other names, and approved uses differ by product and country. The trials below used standard and soluble tablets. The dose comes from the label of the product or from a prescriber.

Cochrane results at 2 hours

Rabbie 2013 reviewed 9 studies with 4,373 participants and 5,223 attacks. A 2017 search found no new studies. Results for the two doses analysed, with placebo in the same comparison:

Outcome at 2 hours	Lower dose	Placebo	Higher dose	Placebo
Pain-free	20%	10%	26%	12%
Headache relief	52%	37%	57%	25%

Headache relief means moderate or severe pain reduced to mild or none. Soluble tablets gave more relief than standard tablets at 1 hour, but not at 2 hours. Adverse events were mostly mild and transient, at rates similar to placebo. Data on serious adverse events were insufficient.

The authors concluded that ibuprofen relieves pain in about half of people, and that complete relief is seen in a minority.

Label warnings

Prescription ibuprofen labels carry a boxed warning for serious cardiovascular and gastrointestinal events: heart attack and stroke, and bleeding, ulceration and perforation that can be fatal and can occur without warning symptoms. They say ibuprofen must not be used with known hypersensitivity to it, after asthma, urticaria or allergic-type reactions to aspirin or other NSAIDs, or in the setting of coronary artery bypass graft surgery.

The non-prescription Motrin IB Migraine label includes these warnings:

• Allergy. Severe allergic reactions can occur, especially in people allergic to aspirin. Do not use after an allergic reaction to another pain reliever or fever reducer.
• Stomach bleeding. The risk is higher from age 60, with past ulcers or bleeding, with blood thinners, steroids or other NSAIDs, and with 3 or more alcoholic drinks a day.
• Heart and stroke. NSAIDs, except aspirin, increase the risk of heart attack, heart failure and stroke. Do not use right before or after heart surgery.
• Aspirin for the heart. Ask a doctor or pharmacist first when taking aspirin for heart attack or stroke, because ibuprofen may decrease this benefit.
• Pregnancy. Ask a health professional before use. The label says it is especially important not to use ibuprofen at 20 weeks or later unless a doctor directs it.

The label also tells people to ask a doctor first in several situations, including migraine never diagnosed by a health professional, a headache unlike the usual ones, the worst headache of one’s life, a first headache after age 50, fever with a stiff neck, daily headaches, migraine requiring bed rest, high blood pressure, heart disease, liver cirrhosis, kidney disease, asthma, a past stroke, and diuretic use. For under-18s, the directions say to ask a doctor.

Monthly limit: 15 or 10 days

• ICHD-3. Ibuprofen is a non-opioid painkiller: 15 or more days a month for more than 3 months.
• US label. “Headaches may worsen if this product is used for 10 or more days per month.”

The medication days counter and Aurora use the ICHD-3 figure. The label figure is lower, so a count of 10 to 14 days is worth showing to a doctor.

In a headache diary

ICHD-3 treats all non-opioid painkillers as one class. Add days with ibuprofen, naproxen, aspirin and acetaminophen into one total, and record the product name and the pain at 2 hours.