#95 From Headache to Happiness, How to treat a migraine

CLINICAL QUESTION

QUESTION CLINIQUE

Are over-the-counter medications similar in effectiveness to prescription medications?

BOTTOM LINE

RÉSULTAT FINAL

Many over the counter medications have similar efficacy to prescription medications in the treatment of acute migraine, including acetaminophen, aspirin, ibuprofen, and naproxen. The combination of acetaminophen, aspirin, and caffeine may offer additional benefit.

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

EVIDENCE

DONNÉES PROBANTES

Six systematic reviews on common migraine treatments. Numbers Needed to Treat (NNT) are listed for “two hour pain relief” and “two hour pain free” respectively:

Acetaminophen 1,000 mg (2,942 patients):¹ NNT 5, 12
Aspirin 1,000 mg (4,222 patients):² NNT 5, 9
Ibuprofen 400 mg (2,575 patients):³ NNT 4, 8
Naproxen 500 mg or 850 mg (2,149 patients):⁴ NNT 6, 12
Sumatriptan 50 mg PO (8,102 patients)⁵ NNT 4, 7
Sumatriptan 100 mg PO (7,811 patients):⁵ NNT 4, 5
Sumatriptan 50-85 mg + Naproxen 500 mg (7,345 patients):⁶ NNT 4, 5

Randomized controlled trial (RCT) of 1,555 patients compared acetaminophen 500 mg, aspirin 500 mg, and caffeine 130 mg (AAC) to ibuprofen 400 mg:⁷

AAC was superior on weighted sum pain relief score at two hours, p<0.03.

RCT of 171 patients compared AAC to Sumatriptan 50 mg.⁸

AAC was more effective for sum of pain intensity reduction and mean pain relief at both two and four hours, p<0.05.
Actual number of patients achieving relief or pain free was not reported for either trial of AAC.

Unpublished data on clinicaltrials.gov⁹ includes a RCT of 752 patients comparing AAC to Sumatriptan 100 mg.

Sumatriptan 100 mg was superior for pain free at two hours, NNT=10.

Context:

While the acetaminophen, aspirin, and caffeine combination is available in the United States, it is not available in Canada. The individual components, however, are.
Generic sumatriptan 100 mg is approximately 50 times the cost of all components of AAC combined.
Up to 7% of patients who use triptans will experience “Triptan Syndrome,” which may include chest and neck tightness, heaviness, paresthesias, and chest pain—but is not associated with cardiac outcomes.¹⁰

updated march 8 2017 by evan sehn

Shannon Wesley September 3, 2024

Triptan syndrome only occurs about 7% of people.

lindsay pritchett June 4, 2025

Interesting

Latest Tools for Practice

Derniers outils pour la pratique

June 20, 2025

#392 Mission Slimpossible, Part 3: Tirzepatide for weight loss

Is tirzepatide effective for weight loss?

Read Lire 0.25 credits available Crédits disponibles

June 6, 2025

#391 Trying Tongue-Tie Treatment: Does Frenotomy Fix Feeding Frustrations?

Does surgical frenotomy in infants with ankyloglossia (tongue-tie) improve mother or infant breastfeeding outcomes?

Read Lire 0.25 credits available Crédits disponibles

May 23, 2025

#390 Use the soft touch for buckle fractures?

Is rigid immobilization needed in buckle fractures?

Read Lire 0.25 credits available Crédits disponibles

September 9, 2013

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

🔒 Complete Activity

🔒 Compléter l’activité

Author(s)

Auteur(s)

Christina Korownyk MD CCFP
David Ross MD CCFP

1. Derry S, Moore RA, McQuay HJ. Cochrane Database Syst Rev. 2013; (4):CD008040.

2. Kirthi V, Derry S, Moore RA, et al. Cochrane Database Syst Rev. 2013; (4):CD008041.

3. Rabbie R, Derry S, Moore RA. Cochrane Database Syst Rev. 2013; 4:CD008039.

4. Law S, Derry S, Moore RA. Cochrane Database Syst Rev. 2013; 10:CD009455.

5. Derry CJ, Derry S, Moore RA. Cochrane Database Syst Rev. 2014; 5:CD009108.

6. Law S, Derry S, Moore RA. Cochrane Database Syst Rev. 2016; 4:CD008541.

7. Goldstein J, Silberstein SD, Saper JR, et al. Headache. 2006; 46:444-53.

8. Goldstein J, Silberstein SD, Saper JR, et al. Headache. 2005; 45:973-82.

9. Efficacy and Safety of Acetaminophen, Aspirin and Caffeine With Sumatriptan in the Acute Treatment of Migraine. Available from: http://clinicaltrials.gov/ct2/show/record/NCT01248468?sect=X4376015

10. Dodick D, Lipton RB, Martin V, et al. Headache. 2004; 44(5):414-25.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.