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Migraine: What can I expect from taking diclofenac?

Created: ; Last Update: August 30, 2012.

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Diclofenac can relieve pain and other symptoms in a migraine attack. Side effects are rare.

Migraine is a disorder characterized by episodes of severe headaches that come on suddenly and usually only affect one side of the head. Physical activity may make the pain worse. In adults, migraine attacks can last between four hours and three days, and may be associated with nausea and vomiting. Many people become unusually sensitive to smell, sound and light during migraine attacks. Some people experience abnormal sensations or perceptions before or during a migraine attack. This is called an “aura”. For example, they might see flashing lights or feel a tingling in their arms or legs. These auras may be bothersome, but they do not have any long-lasting effects.

This information is part of a feature on migraines. You can find more on this topic here.

Many people have migraines. They are more common in women than in men: In Germany, 14 out of 100 women and 8 out of 100 men sometimes have migraines. It is not clear exactly what causes migraines. According to one theory, it has something to do with blood vessels in the brain becoming inflamed. The way pain signals are processed in the brain also plays a role. You can find more detailed information about migraines in adults, children and teenagers in our feature on migraines.

Migraine can severely affect quality of life. Drugs for migraines or headaches can relieve the symptoms, but it is important to take them with care: 2 out of 100 people in Germany are estimated to have chronic headaches because they have taken headache drugs too often.

Migraine medication

Resting in a dark and quiet room already helps some people when they have a migraine attack. Many people put a cooling pad or a wet towel on the side of the head that hurts. A number of different medications are also available:

  • Painkillers: These include non-steroidal anti-inflammatory drugs (NSAIDs) like acetylsalicylic acid (ASA, or ASS in German), ibuprofen, diclofenac and naproxen, as well as acetaminophen (paracetamol).
  • Drugs against nausea and vomiting (antiemetics): These include drugs like metoclopramide or domperidone, and are sometimes taken in addition to migraine drugs or painkillers.
  • Triptans: These are medications developed especially for migraine.

Our fact sheet “Medications for the treatment of migraine attacks in adults” gives you an overview of these drugs.

Taking diclofenac for migraine

Medications containing the drug diclofenac relieve pain and reduce inflammation. Diclofenac is mainly used to treat pain caused by muscle and bone problems like osteoarthritis. But some people also use it to treat mild to moderate migraine attacks. In Germany, pharmacies sell diclofenac without prescription – but only in dosages of 25 mg per tablet. When used to treat migraines, however, doses of 50 to 100 mg are taken. The maximum dose of diclofenac for otherwise healthy adults is 150 mg per day and should not be exceeded to ensure safe use.

Migraine can be accompanied by nausea and vomiting. This is very unpleasant and might also affect the efficacy of the painkillers: If someone vomits, it is possible that not all of the drug gets into the body. This is why some people also take antiemetics for nausea and vomiting.

Research on diclofenac for migraines

To be able to tell how effectively different drugs work in treating migraine, conclusive comparative trials are needed. These kinds of trials compare diclofenac and a fake medication (placebo) or a different migraine medication, for example. You can read more about how good trials are done and why it is important to have comparable groups of participants in our category “Evidence-based medicine”.

Researchers from the Cochrane Collaboration systematically evaluated these kinds of trials on diclofenac. The Cochrane Collaboration is an independent international research network. The researchers particularly looked into the following questions:

  • How effectively does diclofenac relieve pain?
  • How effectively can it relieve other symptoms associated with migraine, such as nausea, vomiting or sensitivity to light and sound?

The researchers evaluated five trials with a total of just over 1,300 participants who had migraine regularly. According to standard recommendations, diclofenac was given in single doses between 50 mg and 100 mg. Diclofenac was mostly used in combination with potassium so that it can dissolve more easily and start working more rapidly.

Diclofenac relieves headaches better than placebo

The trials show that diclofenac can relieve headache partly or completely after a short time. Trials with 50 mg of diclofenac – the dosage that was studied best – showed the following results:

  • 22 out of 100 people who were taking diclofenac were free of pain after two hours.
  • 11 out of 100 people who were taking a placebo were free of pain after two hours.

In other words, 11 out of 100 people were free of pain after two hours because they had taken 50 mg of diclofenac.

In another 16 out of 100 people, their headaches did not go away completely, but were at least reduced by diclofenac. Additional symptoms like nausea, vomiting and sensitivity to light and sound also probably get better. But only a few trials looked into this question.

It is not clear whether a higher dosage of 100 mg can relieve the symptoms more effectively than a dosage of 50 mg. This has not been studied enough yet.

Diclofenac seems to have a similar effectiveness as other drugs from the group of non-steroidal anti-inflammatory drugs like ASA and ibuprofen. But only a few trials compared the drugs directly with one another. So there might be small differences between the drugs. This also depends on what dosages of drugs are used for the comparison.

Side effects

Diclofenac can have side effects. In the trials described above, diclofenac did not have more side effects than a placebo. But because diclofenac affects blood clotting, it can increase the risk of bleeding, particularly if taken regularly. Diclofenac can also cause stomach ulcers, particularly in people who are prone to this problem. This includes those who have already had a stomach ulcer. If you belong to this group of people, acetaminophen can be an alternative option. You can find out more about this in a research summary on treating migraine with acetaminophen.

Choice of medication depends on the individual case

Which medications relieve the symptoms best in an individual case depends on various things. These include the severity of pain and personal preferences: People who mainly want symptom relief as quickly as possible might go for a drug that acts faster. For other people, maximum relief is the most important thing, even if the medication takes a little longer to start working. Others might prefer drugs with a longer-lasting effect. Particularly if an attack is very painful, some people use several drugs to cope with it. The researchers have not studied how helpful this is, though. You can discuss which medication might be the best for you with your doctor or pharmacist.

People react differently to different medications. It cannot be predicted which one works best in an individual case. So if one medication is not working for you, it does make sense to try another one.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: June 2015. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced".

References

  • IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews”. These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in the category “Evidence-based medicine”. We also have our health information reviewed to ensure medical and scientific accuracy.
  • Derry S, Rabbie R, Moore RA. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2012; (2): CD008783. [Summary] [PubMed: 22336852]
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