Researchers conducted a systematic review and meta-analysis to compare the effectiveness of paracetamol and ibuprofen in the treatment of episodic tension-type headaches.
Study: Paracetamol versus ibuprofen for episodic tension-type headache: a systematic review and network meta-analysis.
Tension headaches are the most common type of headache and can occur frequently, occasionally, or chronically. The global prevalence of tension headaches is approximately 26%, affecting 1.89 billion people worldwide. Stress and tension are the most common causes of this type of headache.
Tension headaches can be treated with non-pharmacological or pharmaceutical methods. Non-pharmacological interventions include relaxation therapy and cognitive therapy. Among pharmacological interventions, nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol are the most widely recommended options.
Many randomized controlled trials have been conducted worldwide to examine the effectiveness of NSAIDs and paracetamol in the treatment of episodic tension-type headaches. The most widely recommended treatments include nonsteroidal anti-inflammatory drugs, acetaminophen, combinations of aspirin, paracetamol, and caffeine, and combinations of acetaminophen and caffeine.
In this systematic review and meta-analysis, researchers compared the effectiveness of ibuprofen (NSAID) and paracetamol in the treatment of episodic tension-type headaches.
Various scientific databases were searched for randomized controlled trials published between 1988 and 2022 that examined the effectiveness of ibuprofen and paracetamol in the treatment of episodic tension-type headaches.
A total of 14 studies were included in the final qualitative and quantitative (meta-analysis) review. The studies included a total of 6,521 adult participants with episodic tension-type headache who received paracetamol, ibuprofen or any placebo drug. Across all studies, mean headache intensity at baseline was moderate to severe.
Of the selected studies, one compared paracetamol with ibuprofen, six compared paracetamol with placebo, and six compared ibuprofen with placebo. In terms of methodological quality, approximately 50% of the studies had a low risk of bias in terms of random sequence generation. High attrition rates and risk of reporting bias were observed in three and two studies, respectively. Double-blindness was inconsistent across all selected studies.
Ibuprofen is more effective than acetaminophen in patients with episodic tension-type headaches, based on pain-free status two hours after dosing. Paracetamol has been shown to be more effective than ibuprofen based on pain-free status one hour after dosing. However, these differences were not statistically significant.
Only one study that directly compared acetaminophen and ibuprofen did not find any significant differences between the two treatments in reducing the symptoms of episodic tension-type headaches. Additionally, participants who took acetaminophen were less likely to use quick-acting medications (rescue medications) than those who took ibuprofen or placebo.
Regarding drug-related adverse events, all selected studies reported only minor adverse events. Although stomach upset and dizziness are the most common side effects associated with acetaminophen use, ibuprofen use is primarily associated with nausea and dizziness.
There were no statistically significant differences in the incidence or intensity of adverse events between acetaminophen and ibuprofen.
This systematic review and meta-analysis found no statistically significant difference between paracetamol and ibuprofen in achieving pain-free status after one or two hours of use.
People who took acetaminophen were less likely to use rescue medications than those who took ibuprofen or a placebo, according to the study. However, this is not statistically significant.
European Federation of Neurological Societies (EFNS) and British Association for the Study of Headache (BASH) guidelines recommend the use of ibuprofen rather than paracetamol for the treatment of episodic tension-type headaches. Danish and Canadian guidelines recommend ibuprofen or paracetamol as first-line treatment. However, these recommendations are not based on systematic reviews.
As the scientists noted, this systematic review and meta-analysis included only one study that directly compared the therapeutic effects of paracetamol and ibuprofen. Moreover, all selected studies suffered from one or more biases, which directly reflects the methodological quality of these studies. These are several limitations that should be considered in future studies.
In addition, the scientists emphasized the need for further meta-analysis of head-to-head studies to directly compare paracetamol and ibuprofen.
Post time: Jan-17-2024