Paracetamol and ibuprofen equally effective for tension-type headaches, study reveals

Scientists have conducted a systematic review and meta-analysis to compare the effectiveness of paracetamol and ibuprofen in treating episodic tension-type headaches.

The research paper is published in the journal Scientific Reports

Study: Paracetamol versus ibuprofen in treating episodic tension-type headache: a systematic review and network meta-analysis. Image Credit: Artem Furman / ShutterstockStudy: Paracetamol versus ibuprofen in treating episodic tension-type headache: a systematic review and network meta-analysis. Image Credit: Artem Furman / Shutterstock

Background

Tension-type headache is the most common type of headache that could be frequently episodic, infrequently episodic, or chronic in nature. With a global prevalence of around 26%, tension-type headache affects 1.89 billion people worldwide. Stress and mental tension are the most common triggers for this headache.

Tension-type headaches can be treated with non-pharmacological or pharmacological interventions. Non-pharmacological interventions include relaxation therapy and cognitive therapy. Among pharmacological interventions, the most widely recommended options include non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol.

Many randomized controlled trials have been conducted worldwide to study the effectiveness of NSAIDs and paracetamol in treating episodic tension-type headaches. The most widely suggested treatments include NSAIDs, paracetamol, aspirin-paracetamol-caffeine combination, and paracetamol-caffeine combination.

In this systematic review and meta-analysis, scientists have compared the therapeutic efficacy of ibuprofen (NSAID) and paracetamol against episodic tension-type headaches.

Study design

Various scientific databases were searched to select randomized controlled trials published between 1988 and 2022 and investigated the therapeutic efficacy of ibuprofen and paracetamol against episodic tension-type headaches.

A total of 14 studies were included in the final qualitative and quantitative (meta-analysis) assessments. These studies involved a total of 6,521 adult participants who had episodic tension-type headaches and were treated with paracetamol, ibuprofen, or any placebo drugs. In all studies, the average intensity of headache at baseline was moderate to severe.

Of selected studies, one compared paracetamol with ibuprofen, six compared paracetamol with a placebo, and six compared ibuprofen with a placebo. Regarding methodological quality, about 50% of studies had a low risk of bias in random sequence generation. High attrition and reporting bias risks were observed in three studies and two studies, respectively. Double blinding was inconsistent in all selected studies.

Important observations

Considering pain-free status after two hours of medication, ibuprofen showed higher effectiveness than paracetamol in individuals with episodic tension-type headaches. Considering pain-free status after one hour of medication, paracetamol showed higher effectiveness than ibuprofen. However, these differences were not statistically significant.  

Only one study that directly compared paracetamol and ibuprofen could not find any significant difference between the treatments in reducing episodic tension-type headache symptoms. Furthermore, the lowest probability of using quick-relief medication (rescue medication) was observed among participants who consumed paracetamol than those who consumed ibuprofen or placebo.

Regarding medication-related adverse events, all selected studies reported only mild adversities. While stomach discomfort and dizziness were the most reported adversities related to paracetamol use, ibuprofen use was mainly associated with nausea and dizziness.

No statistically significant differences in the rate or intensity of adverse events were observed between paracetamol use and ibuprofen use.

Study significance

This systematic review and meta-analysis could not find any statistically significant difference between paracetamol and ibuprofen in achieving pain-free status after one hour or two hours of use.

According to the study findings, individuals taking paracetamol are less likely to use rescue medication than those taking ibuprofen or placebo. However, this is not a statistically significant difference.

The European Federation of Neurological Societies (EFNS) and British Association for the Study of Headache (BASH) guidelines recommend ibuprofen over paracetamol in treating episodic tension-type headaches. The Danish and Canadian guidelines recommend ibuprofen or paracetamol as first-line therapy. However, these guidelines are not based on systematic reviews.

As mentioned by the scientists, this systematic review and meta-analysis included only one study that directly compared the therapeutic efficacy of paracetamol and ibuprofen. Moreover, all selected studies had one or more biases, which directly reflect the methodological quality of these studies. These are the few limitations that should be addressed in future studies.

Moreover, the scientists highlight the need for further meta-analyses of head-to-head trials to compare paracetamol and ibuprofen directly.

Journal reference:
Dr. Sanchari Sinha Dutta

Written by

Dr. Sanchari Sinha Dutta

Dr. Sanchari Sinha Dutta is a science communicator who believes in spreading the power of science in every corner of the world. She has a Bachelor of Science (B.Sc.) degree and a Master's of Science (M.Sc.) in biology and human physiology. Following her Master's degree, Sanchari went on to study a Ph.D. in human physiology. She has authored more than 10 original research articles, all of which have been published in world renowned international journals.

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