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

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

The research paper is published within the journal Scientific Reports

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


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

Tension-type headaches might be treated with non-pharmacological or pharmacological interventions. Non-pharmacological interventions include rest therapy and cognitive therapy. Amongst pharmacological interventions, essentially the most widely beneficial options include non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol.

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

On 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 pick randomized controlled trials published between 1988 and 2022 and investigated the therapeutic efficacy of ibuprofen and paracetamol against episodic tension-type headaches.

A complete of 14 studies were included in the ultimate qualitative and quantitative (meta-analysis) assessments. These studies involved a complete 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 common intensity of headache at baseline was moderate to severe.

Of chosen studies, one compared paracetamol with ibuprofen, six compared paracetamol with a placebo, and 6 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 chosen studies.

Essential 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. Nonetheless, these differences weren’t statistically significant.  

Just one study that directly compared paracetamol and ibuprofen couldn’t find any significant difference between the treatments in reducing episodic tension-type headache symptoms. Moreover, the bottom probability of using quick-relief medication (rescue medication) was observed amongst participants who consumed paracetamol than those that consumed ibuprofen or placebo.

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

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

Study significance

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

Based on the study findings, individuals taking paracetamol are less prone to use rescue medication than those taking ibuprofen or placebo. Nonetheless, this shouldn’t be 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. Nonetheless, these guidelines are usually not based on systematic reviews.

As mentioned by the scientists, this systematic review and meta-analysis included just one study that directly compared the therapeutic efficacy of paracetamol and ibuprofen. Furthermore, all chosen studies had a number of biases, which directly reflect the methodological quality of those studies. These are the few limitations that must be addressed in future studies.

Furthermore, the scientists highlight the necessity for further meta-analyses of head-to-head trials to match paracetamol and ibuprofen directly.

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