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Pirprofen for acute migraine

Clinical bottom line:

Based on a small number of patients, oral pirprofen 400 mg is effective for the acute treatment of migraine. About 26% patients aborted a migraine attack with a single dose. Pirprofen 400 mg given as a rectal suppository reduced headache duration (mean 10 hours) in a small number of patients, but whether this is clinically relevant is questionable.


  • Date review completed: November 2000
  • Number of trials included: 2 randomised controlled trials
  • Control group: Active and placebo
  • Main outcomes: Headache intensity and duration

Inclusion criteria were: treatment of acute migraine with pirprofen by any route; randomised allocation to treatment groups; double-blind design; adult population and headache outcomes.

Search

Comprehensive searches of the following databases were made: MEDLINE (1966 - July 2000), EMBASE (1980 - June 2000), Cochrane Library (Issue 3, 2000) and the Oxford Pain Relief Database (1950 - 1994). A series of free text searches were undertaken, using generic and trade names for pirprofen. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.

Findings

Two randomised, double blind, placebo controlled trials were found investigating pirprofen 400 mg given as a rectal suppository in one trial and in tablet form in the other ( Table ). A total of 101 patients were randomised to pirprofen and 101 to placebo. Both trials were of high quality, scoring 3 and 4 out of a maximum of 5, based on criteria that evaluates randomisation, blinding and withdrawals. Both trials were crossover design where each patient received each drug once for a separate migraine attack.

In one trial, based on a sub-group analysis of the migraine patients, there was no significant difference between pirprofen 400 mg (rectal) and placebo for pain intensity over four hours, but a significant reduction in headache duration. However, mean duration of migraine was about ten hours with pirprofen.

In the other trial pirprofen 400 mg (oral) provided significantly better pain relief than placebo after a single dose with 26% of patients needing only one dose of pirprofen to abort a migraine attack compared with 10% for placebo.

Adverse effects

No serious adverse effects were reported, all were mild and of short duration.

References

Guidotti M, Zanasi S, Garagiola U. Pirprofen in the treatment of migraine and episodic headache attacks: a placebo controlled crossover clinical trial. J Int Med Res 1989; 17:48-54

Kinnunen E, Erkinjuntti T, Farkkila M et al. Placebo controlled double blind trial of pirprofen and an ergotamine tartrate compound in migraine attacks. Cephalalgia 1988; 8:175-9