A Comparison of Efficacy and Safety of Non-steroidal Anti-inflammatory Drugs versus Acetaminophen in the Treatment of Episodic Tension-type Headache: A Meta-analysis of Randomized Placebo-controlled Trial Studies

Abstract

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used in the treatment of tension headache. The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen and NSAIDs using meta-analysis of randomized placebo-controlled trial studies.MethodsWe searched MEDLINE, EMBASE, CINAHL, Cochrane, KMbase, KoreaMed, RiCH, National Assembly Library, Riss4u, and DBPIA for studies released through 27th July 2010. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. Review Manager 5.0 was used for statistics.ResultsWe identified 6 studies. The relative benefit of the NSAIDs group compared to the acetaminophen group for participants with at least 50% pain relief was 1.18 (95% confidence interval [CI], 0.99 to 1.39; I2 = 85%). We did subgroup analysis based on allocation concealment versus non-allocation concealment, and low-dose NSAIDs versus high-dose NSAIDs. The relative benefit of the low-dose NSAIDs subgroup to the acetaminophen group was 0.98 (95% CI, 0.91 to 1.06; I2 = 0%). However, the heterogeneity of other subgroup analysis was not settled. The relative risk for using rescue medication of the NSAIDs group compared to the acetaminophen group was 0.84 (95% CI, 0.64 to 1.12; I2 = 47%). The relative risk for adverse events was 1.31(95% CI, 0.96 to 1.80; I2 = 0%).ConclusionIn this meta-analysis, there was no difference between low-dose NSAIDs and acetaminophen in the efficacy of the treatment for tension type headache. The results suggested that high-dose NSAIDs have more effect but also have more adverse events. The balance of benefit and harm needs to be considered when using high-dose NSAIDs for tension headache.

Protective Effects of Acetaminophen on Ibuprofen-Induced Gastric Mucosal Damage in Rats with Associated Suppression of Matrix Metalloproteinase

“…However, unlike NSAIDs, it does not cause gastric mucosal damage (Lanza et al, 1998;Yoon et al, 2012). Although the analgesic mechanism of APAP remains unclear and requires further elucidation, it is suggested that APAP may act centrally and be a weak inhibitor of PG synthesis (Anderson, 2008).…”

A Comparison of the Efficacy and Safety of Non-Steroidal Anti-Inflammatory Drugs versus Acetaminophen in Symptom Relief for the Common Cold: A Meta-Analysis of Randomized Controlled Trial Studies

“…Based on previous studies, high does NSAIDs could be relatively more effective for pain control 22). However, more adverse effects on the gastrointestinal system were reported in NSAIDs.…”

Paracetamol for pain in adults

“…One systematic review (seven randomised controlled trials, 2421 participants) has shown that ibuprofen (an NSAID) is superior to paracetamol for pain associated with the surgical removal of wisdom teeth 31. Paracetamol appears to have similar efficacy to NSAIDs for the treatment of headache32 (systematic review of six randomised controlled trials, 2162 participants) and similar efficacy to NSAIDs and opioids for the treatment of renal colic (systematic review of 36 randomised controlled trials, 4887 participants) 33…”