Research Finds Three Medications with Better Efficacy for Migraine Treatment than Ibuprofen

A new study suggests that ibuprofen may not be the best remedy for migraines.

Despite their popularity, household brands might not be the most potent treatments for certain ailments.

The recent research featured in Neurology reveals that, while many people employ over-the-counter medicines like ibuprofen to ease migraines, different types of drugs designed specifically for migraines could be up to five times more successful.

The study also found that non-steroidal, anti-inflammatory drugs (NSAIDs) other than ibuprofen had greater effectiveness.

Chia-Chun Chiang, MD, who led the study and works as an assistant professor of neurology and headache specialist at the Mayo Clinic in Rochester, Minnesota, advises those that rely heavily on over-the-counter drugs for headache treatment to consult a doctor, as better options that are specifically made for migraines are available.

A list of migraine medication that could likely drive better results is presented in the study.

To gather the data, Chiang and her team analysed 25 different types of migraine medications, using a smartphone app.

The app provided 4.7 million+ records indicating which medications participants used for migraines and their effectiveness rates. It allowed the researchers to identify the most successful classes and individual drugs for migraine treatment.

The study highlighted three drug classes - triptans, ergots, and antiemetic medications, that outperformed ibuprofen in treating migraines.

Triptans, which affect serotonin receptors in the brain, were found to be five times more effective than ibuprofen. This group includes medications such as Migranow (sumatriptan), Zomig (zolmitriptan), Frova (frovatriptan), and Relpax (eletriptan).

Ergots are alkaloids, sometimes mixed with caffeine, and were found to be three times more effective than ibuprofen. Drugs in this class include Ergomar, Migranal, and Trudhesa.

Antiemetic medications like Reglan, Compazine, and chlorpromazine, used for nausea treatment, were nearly three times more successful than ibuprofen when combined with dihydroergotamine in resistant cases.

The most potent medications identified in the study were eletriptan, zolmitriptan, and sumatriptan, all of which are triptans.

The study found that while migraines were managed by ibuprofen in around 42% of cases, migraine-specific medicines, mainly triptans, yielded success rates between 72% and 78%.

NSAIDs, apart from ibuprofen, and prescription drugs like ketorolac, indomethacin, and diclofenac proved to be more effective than ibuprofen. Acetaminophen, the major component in Tylenol, was 17% less potent than ibuprofen.

Chiang confirmed to Health that the study's findings were in line with those from previous randomized clinical trials.

The distinction is that this is the first study to use real patient data for a comprehensive comparison of 25 medications.

Despite the valuable insights gleaned from the study, some limitations exist. It covered data collected up until 2020 for a period of six years. However, certain newly-approved migraine drugs have not been accommodated in this data.

Dr. Hope O'Brien, founder and medical director of Headache Center of Hope in Cincinnati, Ohio, pointed out that the study omitted dosing amounts and didn't include any of the newly available migraine treatments. However, the study does affirm the widely known fact that migraines are often under-treated.

According to the study, almost half of the patients reported inadequate pain management, and a third stated they required multiple drugs to handle their migraine pain. O'Brien emphasizes that this is indeed problematic.

The study did not specify how the drugs were taken (by pill, injection or nasal spray) which could influence their effectiveness. "Considerable research is required to authenticate the impact of different doses and forms of various drugs," said Chiang, advocating that newer migraine medications should be tested in future studies.

Notwithstanding these gaps in findings, Chiang pointed out that the study offers a new perspective on research methodologies.

“Traditionally we get data from randomized controlled studies or electronic health records,” she said. “This is the first study to use data on medications for migraine generated from patients through an online electronic diary.”

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.