Intravenous ibuprofen for acute treatment of migraine: A double-blind, randomized, placebo-controlled pilot study.

Abstract

To evaluate the efficacy and safety of intravenous (IV) Ibuprofen for acute treatment of migraine. IV nonsteroidal anti-inflammatory drugs (NSAIDs) are an alternative to oral NSAIDs, especially in patients with severe migraine who have emesis or gastroparesis. To date, only three IV NSAIDs (ketorolac, ibuprofen, and meloxicam) are available in the United States for use in moderate and severe pain, but no placebo-controlled trial is available for migraine. We performed a single-center, double-blind, randomized, placebo-controlled pilot study to evaluate the efficacy and safety of IV ibuprofen as an acute treatment of migraine (NCT01230411). Individuals with episodic migraine were screened at the Jefferson Headache Center. Qualified subjects were treated for migraine attacks within 2-72h following the headache onset with either 800mg of IV ibuprofen or placebo in 250ml saline bolus. Migraine pain intensity (4-point Likert scale) and associated symptoms were assessed at predetermined time points (0.25, 0.5, 1, 1.5, 2, 4, 8, 24h). The primary endpoint was pain relief at 2h after infusion. Important secondary endpoints included pain freedom at 2h, sustained relief over 24h, use of rescue therapy, and absence of associated symptoms. Adverse events (AEs) were also collected. Seventy-four participants were enrolled between 2011 and 2017. Forty-four subjects (female 33/44; 75.0%) with mean (SD) age 41.0 (11.2) 11.2 years came for the treatment. All treated subjects (n=44) were included in the analysis. Among them, 23 were randomized to receive IV ibuprofen. Both groups were demographically similar except for longer migraine duration (i.e., years lived with disease) in the active treatment than in the placebo group. At 2h posttreatment, pain relief was found in 74% (17/23) and 48% (10/21) after IV ibuprofen and placebo, respectively (odds ratio [OR] 3.12, 95% CI: 0.88-11.0; p=0.078). Other secondary endpoints at 2 and 24h were not significant. The longitudinal repeated-measures analysis within 2h on ibuprofen treatment showed significant pain relief (OR 2.47, 95% CI 1.08-5.7; p=0.033) and absence of associated symptoms: photophobia (OR 4.0, 95% CI 1.57-10.3; p=0.004), phonophobia (OR 3.12, 95% CI 1.16-8.4; p=0.025), and osmophobia (OR 3.45, 95% CI 1.01-11.8; p=0.048). AEs were observed in seven subjects in both groups, with arm pain being the most common. No serious AE was reported. This study did not meet the primary endpoint but showed pain relief and elimination of several associated symptoms within 2h on repeated-measures analysis. Although limited by small sample size and high placebo response, our results indicate that IV ibuprofen may be a safe and effective option for acute treatment of migraine, but more extensive studies are necessary.