Naproxen for migraine

What the labels say about migraine

Naproxen is an NSAID. Migraine is not listed on the naproxen labels opened for this page:

• Prescription tablets and oral suspension. Indications include arthritis conditions, tendonitis, bursitis, acute gout, pain and primary dysmenorrhea.
• Aleve (naproxen sodium), non-prescription. Uses include minor aches and pains, among them headache.
• Treximet. This prescription tablet combines sumatriptan with naproxen sodium and is indicated for acute migraine in adults and in patients 12 and older. Its boxed warning covers serious cardiovascular and gastrointestinal events. This page deals with naproxen alone.

Use for migraine outside a label’s indications is a decision for a prescriber. Doses come from the label or the prescriber. Approved uses differ by country.

Cochrane results at 2 hours

Law 2013 reviewed six studies: 1,241 participants took naproxen and 1,092 placebo. Results pool the two doses reviewed.

Outcome at 2 hours	Naproxen	Placebo	Number needed to treat
Pain-free	17%	8%	11
Headache relief	45%	29%	6.0

Adverse events, such as dizziness, sleepiness, nausea and indigestion, were mostly mild or moderate and rarely caused withdrawal. They were more common than with placebo in the pooled analysis, but not at the lower dose alone.

The authors found naproxen statistically superior to placebo. Because of the number needed to treat of 11, they concluded that it is not clinically useful as a stand-alone painkiller in acute migraine. This is a judgement about group results, not about any one person.

Boxed warning and contraindications

The prescription naproxen label carries a boxed warning for serious cardiovascular and gastrointestinal events: heart attack and stroke, and bleeding, ulceration and perforation that can be fatal and can occur without warning symptoms.

The label says naproxen must not be used:

• with known hypersensitivity to naproxen;
• with a history of asthma, urticaria or allergic-type reactions after aspirin or other NSAIDs;
• in the setting of coronary artery bypass graft surgery.

Further warnings cover liver and kidney toxicity, hypertension, heart failure, serious skin reactions and fetal toxicity. Listed interactions include anticoagulants, antiplatelet medicines, SSRIs and SNRIs, aspirin and other NSAIDs, ACE inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, lithium and methotrexate.

The Aleve label says not to use it right before or after heart surgery. It tells people to ask a doctor first with high blood pressure, heart disease, kidney disease, liver cirrhosis or asthma, or when taking a diuretic, and to avoid use at 20 weeks or later of pregnancy unless a doctor directs it.

Monthly limit

ICHD-3 groups naproxen with the other non-opioid painkillers: 15 or more days a month for more than 3 months, and days with different medicines in this class add up. The medication days counter follows this rule.

In a headache diary

Note the product, since naproxen and naproxen sodium appear under different names, and whether any second medicine was taken the same day. Record pain at 2 hours. If naproxen is used with a triptan, a day with both counts once toward any-medicine days, and that total has a limit of 10 days.