NSAIDs – Which One Should I Take For Headache?

NSAIDs, or nonsteroidal anti-inflammatory drugs, are frequently prescribed for pain, including headache. They are also used for fever, and to lower inflammation (obviously). But there are a wide variety of NSAIDs – if I’m going to take one, which one should I reach for?

It should be said that, although most NSAIDs are considered to be fairly mild medications, they are not without risk. For example, there is a certain risk in pregnancy (especially early pregnancy). They can reduce blood clotting, which can be dangerous for some. They can cause unpleasant stomach and bowel symptoms, such as heart burn and constipation.

So how can I find the medication that provides the most relief with the fewest symptoms?

If you’re going to use NSAIDs for a rare headache attack, here are some of the best, according to current research.

• Aspirin: Yes, believe it or not, the old stand-by has helped many people fight off migraine attacks. This study showed that a single 1000mg dose can be quite helpful for some. There is, however, some risk of gastrointestinal problems. If you can, take aspirin during/after meals, try to use a brand name you trust with coated tablets, and avoid time-release.
• Diclofenac: This one comes with more risk than aspirin. Along with possible gastrointestinal issues, it also raises your risk of cardiovascular problems. Unless you are low risk and nothing else is working, this is probably one to avoid.
• Ibuprofen: This is a bit of a trade-off compared to aspirin. There is less risk of gut issues (although the risk is still there), but a little more of a risk of cardiovascular problems. Again, look for a brand name you trust, find coated tablets or something designed to be easy on the stomach, and eat with meals if you can. Of course, avoid time-release versions. Ibuprofen dosage information here. Note that for migraine, the dosage will be on the high side – 400-800mg.
• Naproxen: Naproxen carries a similar risk of stomach issues as aspirin, but the cardiovascular risk is slightly higher. However, the risk is lower than with ibuprofen. So if the other two aren’t working, consider this alternative. A suggested dosage is 220-440mg.
• Etodolac: This one is less often mentioned for migraine and headache, but is worth considering because, like ibuprofen, it’s easier on the stomach. The cardiovascular risk is lower than ibuprofen, though still higher than aspirin. Dosages between 400 and 800mg may be helpful. One study on etodolac here.

There are other alternatives, but these are probably the ones your doctor will recommend first. Remember, it is wise to talk to your doctor.

Also remember that if you’re reaching for these often, there’s a more serious problem and you should talk to your doctor. These can be helpful, but only for the very occasional headache.

Special thanks to Clinical Resource, Managing NSAID Risks. Pharmacist’s Letter/Prescriber’s Letter. January 2017