Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

Open Access

P003. NSAIDs for symptomatic treatment of headache

  • Giannapia Affaitati1Email author,
  • Paolo Martelletti2,
  • Mariangela Lopopolo1,
  • Claudio Tana3,
  • Francesca Massimini4,
  • Francesco Cipollone1,
  • Domenico Lapenna1,
  • Maria Adele Giamberardino1 and
  • Raffaele Costantini5
The Journal of Headache and Pain201516(Suppl 1):A162

https://doi.org/10.1186/1129-2377-16-S1-A162

Published: 28 September 2015

Background and aims

Clinical observations suggest that the use of non-steroidal anti-inflammatory drugs (NSAIDs) for symptomatic treatment of headache is not in line with recommendations by international guidelines [1]. The aim of the study was to evaluate NSAIDs use for episodic headache at the Headache Centre of the Chieti University in the period: January 2000-February 2013.

Methods

A retrospective evaluation was carried out on 6,443 records of episodic migraine (n=2,330), tension-type headache (TTH) (n=807) and migraine + TTH (n=3,306) sufferers relative to NSAID use for the acute attack: type of NSAID/s; uni- or poly-therapy (one or more NSAID/s in different attacks) and NSAID efficacy (subjective scale: complete (C), partial (P) or absent (A) pain relief at 2 hours), at the first visit and 1-year follow-up.

Results

In migraine patients, 80% had been NSAID users in the past year. The three most frequently employed molecules were: nimesulide (57%), ketoprofen (25%) and ibuprofen (24%). Complete vs. incomplete/absent efficacy was significantly higher for all three (p < 0.0001). NSAIDs were replaced with triptans in 53% of the patients at the first visit; after 1 year: a significant spontaneous return to NSAIDs occurred in 56% of the cases (p < 0.0005) for inadequate efficacy/side effects (62%) or difficulty in obtaining prescription (38%) of triptans from the family doctor. In TTH patients, 90% were NSAID users; preferences were: nimesulide (48%), ketoprofen (47%) and diclofenac (19%); complete vs. incomplete/absent efficacy was significantly higher for the first two (p < 0.02). Replacement with analgesics was performed in 24% of the patients at the first visit; at one-year follow-up a spontaneous return to NSAIDs occurred in 29% of the cases for inadequate efficacy of the non-NSAID therapy. In Migraine + TTH patients who were not able to distinguish the nature of their attack at the beginning of the pain, 89% were NSAID users; the three most frequently employed molecules were: nimesulide (44%), ibuprofen (42%) and ketoprofen (38%); complete vs. incomplete/absent efficacy was significantly higher for all three (0.001 < p < 0.0001). Replacement with analgesics was prescribed to 31% of the patients at the first visit; at one-year follow-up a spontaneous return to NSAIDs occurred in 37% of them for inadequate efficacy of the non-NSAID therapy.

Conclusions

NSAID use in episodic headache is higher than could be hypothesized based on guidelines [2]. NSAID role/efficacy, particularly in migraine, should be better understood. A higher degree of sensitization towards different treatment options for headache should also be promoted in the medical environment [3].

Written informed consent to publish was obtained from the patient(s).

Authors’ Affiliations

(1)
Headache Centre, Department of Medicine and Science of Aging, “G. D'Annunzio” University of Chieti
(2)
Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, “Sant'Andrea” Hospital, “Sapienza” University
(3)
Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia
(4)
Institute of Clinical Pathology, “G. D'Annunzio” University of Chieti
(5)
Institute of Surgical Pathology, “G. D'Annunzio” University of Chieti

References

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Copyright

© Affaitati et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.