Efficacy and Safety of Naproxen Sodium in the Acute Treatment of Migraine

Article Review: Meta-analysis of the Efficacy and Safety of Naproxen Sodium in the Acute Treatment of Migraine. Chuthamanee C. Suthisisang, PhD; Nalinee Poolsup, PhD; Naeti Suksomboon, PharmD, PhD; Vorachart Lertpipopmetha, BSc; Bhakanit Tepwitukgid, BSc  Posted: 07/02/2010; Headache. 2010;50(5):808-818.

This article reviews the safety and efficacy of common over-the-counter and prescription NSAIDs (non-steroidal anti-inflammatories) in the treatment of acute migraine attacks.  One of the most common OTC forms of naproxen sodium is Alleve.  This article highlights a number of interesting and important points to consider for migraine sufferers.

Naproxen sodium was more effective than placebo in reducing the pain intensity and the 2-hour pain intensity in moderate to severe cases of acute migraine episodes.

“There was no significant difference in headache recurrence rate between naproxen sodium and placebo.”

This shows that even though symptoms can be reduced, the actual causal factors are not being addressed with these medications.  If they were being addressed and removed then the recurrence rate of migraines would decrease.  Now this commentary should not be interpreted as condemnatory since there are many treatments…natural and conventional…that fail in decreasing migraine recurrence for some patients.  However, there are safer alternatives that should be considered and that will be discussed in more detail later on.

“The adverse events commonly associated with naproxen sodium were nausea, dizziness, dyspepsia and abdominal pain.”

An understanding that NSAID’s block both COX-1 and COX-2 enzymes makes it very clear to see why these side effects are so common.  Gastrointestinal and cardiovascular side effects are common side effects any time both enzymes are blocked.  This is the reason pharmaceutical companies have tried to make safe selective COX-2 inhibitors such as Celebrex and Vioxx which was removed from market due to complications.  For the body to function properly, however, you need both COX-1 and a small activity of COX-2.

“The available evidence suggests that naproxen sodium is more effective but may cause more adverse events than placebo in the acute treatment of moderate to severe migraine. It is effective in reducing headache intensity, rendering pain-free at 2 hours and improving migraine-associated symptoms. However, its effectiveness relative to other active comparators needs to be better defined by appropriate head-to-head clinical trials.”

This is the published conclusion of the abstract for this article.  Naproxen sodium is more effective in reducing migraine headache intensity, but has more adverse events than placebo.  Now some may argue that the benefits (pros) outweigh with the side effects (cons).  The premise of health care should be “First Do No Harm“.  With this understanding if there are other alternatives (and there are) that reduce migraine frequency using the same scales of measurement as in this study, yet without side effects, would it be a viable consideration for patients suffering with migraine?  I think the answer would be a resounding yes.  Who wants to develop gastrointestinal bleeding as a consequence to reducing migraine headaches?

To identify some of the other viable treatment options we need to continue to delve deeper into this meta-analysis of migraine headaches.

“Pharmacologic treatment of migraine attacks primarily aims at alleviating head pain and symptoms accompanying migraine, avoiding headache recurrence, restoring patient’s ability to function, and minimizing the use of rescue medications”

These are the goals of medication usage for migraine.  Similar goals can be achieved with a non-pharmaceutical and physical approach addressing underlying neuromusculoskeletal imbalances.

“Migraine pathophysiology involves a combination of events, including the cortical spreading depression (CSD) and the release of inflammatory mediators such as prostaglandin E2 (PGE2) and nitric oxide which have direct effect on perivascular nociceptors. CSD also triggers the complex mechanisms of afferent and efferent trigeminal vascular events by stimulating the release of calcitonin gene-related peptide (CGRP) from the trigeminovascular system. PGE2 has also been shown to stimulate CGRP release from the primary cultures of adult rat trigeminal neurons. Therefore, NSAIDs that inhibit PGE2 synthesis are effective in treating acute migraine attack.”

The ability to address the cortical spreading depression and increased synthesis of PGE2 are two treatment modalities that have proven efficacy.  As a chiropractic neurologist, I read cortical spreading depression as decreased frequency of firing.  That means areas of the brain that should be balanced and firing in sync are out of order, firing slower and being perceived as pain.  A brain balancing influence is able to increase the frequency of firing in the areas of the brain that are most affected.

The fact that inhibiting PGE2 (an inflammatory cytokine) is effective is also clinically useful.  It is a well established fact that omega-3 fatty acids (fish oils) inhibit the production of the inflammatory cytokine PGE2 yet have no negative side effects.  There is also a body of evidence that shows hops extract containing SKRM’s (selective kinase response modulators) that reduce PGE2 synthesis selectively, but do not negatively affect the gastrointestinal or cardiovascular systems.  These compounds also have little to no negative side effects.

So just presented here are three very simple things a migraine sufferer may consider doing:

  1. Address the cortical spreading depression with a chiropractic neurological assessment that is effective in addressing the issue of function and increasing the frequency of firing of the neurons.
  2. Add or increase dosing of omega-3 fatty acids (caution with use of blood-thinning medications) to decrease PGE2 production.
  3. Take a SKRM, such as Kaprex, for decreased PGE2 production that will not damage the GI or cardio systems.

“Although evidence from clinical studies suggests that naproxen sodium provides better headache relief than placebo in the treatment of migraine headache, it is not yet known whether it offers any clinical benefits taken into account the desired outcomes in acute migraine therapy as recommended by the International Headache Society (IHS)”

When looking at trying to truly treat the migraine headaches, naproxen sodium may be doing little more than placing a band-aid on the situation and never addressing the underlying cause.

“Compared with aspirin, naproxen sodium 500 mg appears to be inferior to aspirin 1000 mg in caplets and effervescent forms in terms of headache relief at 2 hours (43–46% vs 52% and 51.5%), pain-free at 2 hours (15–18% vs 20% and 27.1%), and sustained pain-free (10–12% vs 23.5%). Based on its efficacy, aspirin can be considered as a first-line NSAID for the acute treatment of migraine. However, caution should be applied in patients with poor gastrointestinal and hemostatic tolerabilities.”

The much cheaper aspirin is superior to acute treatment of migraine.  Aspirin, however, is not without its inherent risks and shouldn’t be used with GI issues or dysfunction.  White willow bark, which is also readily available and quite inexpensive, may be another option for migraines.  I have used clinically a blend of white willow bark and feverfew with good success.

It should be mentioned that many headaches, including migraines, can be alleviated by removing food allergens.  Compliance with a modified elimination diet to decrease oligoantigenic load is effective in a large percentage of people with headaches and migraines.

Migraine headaches are a large burden for many people.  They can be frustrating and life-altering.  There are a number of things a migraine sufferer may wish to try.  As this article shows there are things that work, but one must weigh out the consequences of some treatments.

Thanks for taking the time to read and I hope this article review was beneficial for someone that is suffering with migraines.  If it benefits you, or you have tried something that helps you, please comment below.

We are in favor of choosing alternatives that are safe, natural and effective.  This review involves my personal commentary only and should not be construed as information to replace the advice of your medical provider.

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