Alexander W. Chessman, MD
What are the efficacy and safety of acetaminophen for acute migraine headaches in adults?
Included studies compared acetaminophen with placebo or active control in patients ≥ 18 years of age who had migraine headaches. Acetaminophen could be used alone or with an antiemetic. All medications had to be self-administered. Outcomes included freedom from pain at 2 hours (without use of rescue medication), reduction in headache pain (pain reduced from moderate or severe to none or mild without the use of rescue medication) at 1 and 2 hours, and adverse events and major adverse events within 24 hours.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (to Oct 2010); Oxford Pain Relief Database; www.clinicaltrials.gov and www.gsk-clinicalstudyregister.com; and reference lists were searched for double-blind, randomized, controlled trials (RCTs) that had ≥ 10 patients per treatment group and reported dichotomous data for ≥ 1 of the study outcomes. Crossover studies were required to have adequate washout between treatments. 10 RCTs (n = 2769; 4062 migraine attacks; mean age 33 to 49 y) met the selection criteria. Acetaminophen doses were 500 or 1000 mg. All trials had Oxford Quality Scores ≥ 3 out of 5.
The main results are in the Table.
In adults with acute migraine headaches, acetaminophen, taken when pain is moderate or severe, is more effective than placebo for reducing headache pain at 1 and 2 hours and eliminating pain at 2 hours. Acetaminophen with metoclopramide did not differ from sumatriptan, 100 mg, for reducing headache pain at 2 hours. Acetaminophen is associated with fewer adverse and major adverse events than placebo. Acetaminophen with metoclopramide is associated with fewer adverse and major adverse events than sumatriptan.
Acetaminophen (AC), 1000 mg, vs control, taken when pain is moderate or severe, in adults with acute migraine headaches*
*Met = metoclopramide, 10 mg; other abbreviations defined in Glossary. RBI, RBR, RRR, NNT, NNH, and CI calculated from control event rates, risk ratios, and risk differences in article.
Chessman AW. Review: Acetaminophen reduces acute migraine pain in adults. Ann Intern Med. ;154:JC3–9. doi: 10.7326/0003-4819-154-6-201103150-02009
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Published: Ann Intern Med. 2011;154(6):JC3-9.
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