Ketoprofen for acute migraine

Clinical bottom line

Ketoprofen given as a rectal suppository or an intramuscular injection is effective for the acute treatment of migraine. These results are based on a small number of patients, and should be interpreted with caution. No trials of oral ketoprofen were found.


A systematic review of ketoprofen was not found so Bandolier pulled together the evidence for this drug for the acute treatment of migraine. Ketoprofen is an NSAID of proven efficacy for other pain conditions, but does it work for migraine?


Systematic review:

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

Search methods

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 ketoprofen. 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 Neither individual authors nor pharmaceutical companies were contacted for unpublished data.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:

Only two [1,2 ] randomised, double blind trials were found, one placebo controlled and one active controlled (Table). Neither were of orally administered ketoprofen. Both trials were of high quality, 3 and 4 out of a maximum of 5. Neither of the trials used IHS criteria for migraine diagnosis but state the diagnostic criteria used. Both trials presented dichotomous or mean pain intensity data that could be converted to dichotomous data so that an estimate of the percentage of patients achieving the stated outcome could be made (Figure).

One trial [1] compared ketoprofen 100 mg given as a rectal suppository with placebo for three migraine attacks. At two hours, 23/50 (46%) patients reported at least 50% pain relief with ketoprofen and 12/50 (24%) with placebo. The NNT for this outcome was 4.6 (2.5 to 26).

The other trial [2] compared ketoprofen 100 mg given IM with paracetamol 500 mg IM. After 30 to 40 minutes, 28/34 (83%) patients reported complete relief with a single dose of ketoprofen compared with 5/30 (18%) with paracetamol.



Adverse effects

One trial reported on adverse effects and stated that they were rare and minimal.

Comment

Not very much information on which to base policy, and nothing on the oral route.

Further reading

1 Kangasniemi P, Kaaja R. Ketoprofen and ergotamine in acute migraine. J Intern Med 1992; 231:551-4.

2 Karabetsos A, Karachalios G, Bourlinou P, Reppa A, Koutri R, Fotiadou A. Ketoprofen versus paracetamol in the treatment of acute migraine. Headache 1997; 37:12-4.


Related topics


Identifier MI008 - KETOPROFEN FOR MIGRAINE: Nov-2000