Medicine 1: NSAIDs

Medicine 1: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

What is it?

Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature.

NSAIDs are available as tablets, capsules, suppositories (capsules inserted into the bottom), creams, gels, and injections. Some can be bought over the counter from pharmacies, while others need a prescription.

The main types of NSAIDs include:

1. Ibuprofen

2. Naproxen

3. Diclofenac

4. Mefenamic acid

5. Etoricoxib

6. Indomethacin

7. Aspirin ¹

How does it work?

Cyclooxygenase (COX) is the enzyme that mediates the bioconversion of arachidonic acid to inflammatory prostaglandins (PGs).

NSAIDs are competitive inhibitors of COX, thus decreasing the production of prostaglandins, which results in decreased pain.¹

What is the efficacy?

Methods: Multiple high-quality studies, including a systematic review and network meta-analysis, were conducted to evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in the acute treatment of migraines, including menstrual migraines. These studies involved adult participants with diagnosed migraine, including those with menstrual migraine patterns, and compared NSAID efficacy both alone and in combination therapies.²,³,⁴

Results: NSAIDs such as ibuprofen and naproxen showed significant benefit over placebo in achieving 2-hour pain relief and pain freedom. A fixed-dose combination of aspirin, paracetamol, and caffeine significantly improved headache relief and patient satisfaction compared to placebo.

Conclusion: NSAIDs, particularly ibuprofen and diclofenac-potassium, are effective, well-tolerated treatments for managing acute menstrual migraines. Combination therapies, such as aspirin with paracetamol and caffeine, further enhance efficacy and patient satisfaction. These findings support NSAIDs as a viable first-line option for individuals seeking relief from period-related migraine attacks.

Side-effects:

Short-term effects: Nausea, diarrhea.

Long-term effects: Myocardial Infarction, thromboembolic events, and atrial fibrillation.¹

References

1. Patel RM, Patel MM. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan– [cited 2025 May 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547742/

2. Diener HC, Gaul C, Lehmacher W, Weiser T. Aspirin, paracetamol (acetaminophen) and caffeine for the treatment of acute migraine attacks: A systemic review and meta‐analysis of randomized placebo‐controlled trials. European journal of neurology. 2022 Jan;29(1):350-7.

3. Xu H, Han W, Wang J, Li M. Network meta-analysis of migraine disorder treatment by NSAIDs and triptans. The Journal of Headache and Pain. 2016 Dec;17(1):113.

4. VanderPluym JH, Singh RB, Urtecho M, Morrow AS, Nayfeh T, Roldan VD, Farah MH, Hasan B, Saadi S, Shah S, Abd-Rabu R. Acute treatments for episodic migraine in adults: a systematic review and meta-analysis. Jama. 2021 Jun 15;325(23):2357-69.