In Summary, for those who received ibuprofen:

Benefits in NNT

    7% became headache-associated pain-free at 2 hours
    16.7% reported “very good” or “excellent” scores on a global evaluation scale
    11.1% did not use an additional rescue medication
    1 in 14 became headache-associated pain-free at 2 hours
    1 in 6 reported “very good” or “excellent” scores on a global evaluation scale
    1 in 9 did not use an additional rescue medication

Harms in NNT

    0% developed adverse events
    None developed adverse events

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Source: Derry S, Wiffen PJ, Moore RA, Bendtsen L. Ibuprofen for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev. 2015;(7):CD011474.

Study Population: Adult patients with frequent, episodic tension-type headaches

Efficacy Endpoints: Pain-free at one hour, pain-free at two hours, global evaluation, and use of rescue medication within six hours

Harm Endpoints: Any adverse events

Narrative: Tension-type headaches are common.1 Persons who experience one to 14 tension-type headaches per month are defined as having episodic tension-type headaches,2 and ibuprofen is often used for treatment.

This Cochrane review of 12 studies with 3,094 total participants sought to determine the effectiveness of ibuprofen for episodic tension-type headaches.3 All included trials were randomized comparisons of 400 mg of ibuprofen vs. placebo. Although there was no significant difference between ibuprofen and placebo at one hour, more patients treated with ibuprofen were pain-free at two hours (number needed to treat [NNT] = 14) and more likely to report “very good” or “excellent” scores on a global evaluation scale (NNT = 6). There was no significant difference in adverse events between ibuprofen and placebo.

Caveats: Overall, the evidence quality was good, with all studies being randomized and double-blinded. Some of the studies were small and some had inconsistent reporting of outcomes, but the risk for bias was considered low. Given the broad frequency of episodic tension-type headaches, the authors note it is hard to tell from this meta-analysis whether ibuprofen is more or less likely to be beneficial in those who have only one to two headache days per month compared with those who have more frequent headaches because many studies did not report baseline headache frequency. Still, use of ibuprofen seems to be well supported by the evidence in this meta-analysis, as well as by the European Federation of Neurological Societies4

The original manuscript was published in Medicine by the Numbers, American Family Physician as part of the partnership between and AFP.

Author: Joseph Yancey, MD, and Patrick Saas, MD

Published/Updated: May 1, 2016

  1. The Title Bar

    The title bar is color-coded with our overall recommendation.

    • Green: Benefits outweigh risks.
    • Yellow: Unclear risk/benefit profile.
    • Red: Benefits do not outweigh risks.
    • Black: Obvious harms, no clear benefits.
  2. Tip content...