Using Ibuprofen to Prevent Migraines

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that most often is used to relieve pain and bring down fevers. While you may have reached for it to get relief from frequent migraines (or any kind of headache, for that matter), this common analgesic also may have some usefulness as a prophylactic migraine medication—meaning it may prevent or at least decrease the number of migraines a person has.

It's rarely the first drug prescribed by a healthcare provider to head off headaches, as there are several other medications that have been studied more extensively. But in the event your healthcare provider suggests you try taking ibuprofen to prevent migraine headaches, here are some key things to know.

How It Works

Ibuprofen is an anti-inflammatory medicine that curtails the production of prostaglandins—hormone-like substances that are involved in many functions in the body. These include vasodilation, the opening of blood vessels. Research shows that this may be one way in which prostaglandins play a role in migraine headaches.

It stands to reason, then, that by preventing the release of prostaglandins, ibuprofen and other NSAIDs might help to stave off migraine headaches. And although there's been minimal research looking at ibuprofen as a migraine preventive drug, it sometimes is prescribed for that purpose.

In fact, in the 2012 guidelines on preventive therapies for episodic migraine published by the American Academy of Neurology (AAN) and American Headache Society (AHS), ibuprofen is classified as "probably effective." Several other NSAIDs received this rating as well, including fenoprofen, ketoprofen, and naproxen. Episodic migraines are classified by the International Headache Society as headaches that occur fewer than 15 times per month.

Forms and Dosing

Ibuprofen is sold over the counter under a variety of brand names such as Advil and Motrin, as well as generically and as store-branded products.

Over-the-counter ibuprofen comes as a 200-milligram (mg) tablet or a chewable; it's also available as a liquid or drops for children. For the prevention of migraine headaches, the AHS/AAN migraine prevention guideline recommends 200 mg twice a day.

Side Effects

Most side effects of ibuprofen are relatively mild, although there are quite a few potentially serious and rare side effects should prompt you to immediately see a healthcare provider or go to the nearest hospital emergency department.

Common Side Effects

These include a constellation of gastrointestinal symptoms: constipation, diarrhea, gas, or bloating that often can be sidestepped by taking ibuprofen with food or a beverage. Other mild side effects of ibuprofen are dizziness, nervousness, and ringing in the ears.

Severe Side Effects

The ones to be aware of include:

• Unexplained weight gain
• Fever
• Hoarseness
• Excessive tiredness
• Pain in the upper right part of the stomach
• Nausea/loss of appetite
• Yellowing of the skin or eyes or pale skin
• Flu-like symptoms
• Fast heartbeat
• Cloudy, discolored, or bloody urine/difficult or painful urination
• Back pain
• Blurred vision, changes in color vision, or other vision problems
• Red or painful eyes
• Stiff neck
• Headache
• Confusion
• Aggression

Stomach Bleeding

Ibuprofen can cause stomach bleeding, signs of which include black or bloody stools, vomiting of blood, or faintness. This risk is especially high for people who:

• Are over 60
• Have a history of stomach ulcers or bleeding problems
• Take blood thinners or steroids
• Take other NSAIDs, such as aspirin or naproxen
• Drink three or more alcoholic beverages a day
• Take the medication for longer than directed or take more than the recommended dose

Potential Problems During Pregnancy

Pregnant women should take ibuprofen only under the guidance of a healthcare provider, especially during the final three months of pregnancy when there is a risk that ibuprofen might provoke premature closure of a blood vessel connecting the fetus's pulmonary artery to their aorta as well as potentially causing low levels of amniotic fluid, affecting the baby's health.

Allergic Reactions

Although rare, it's also possible to have a severe allergic reaction to ibuprofen that will cause symptoms such as hives, swelling, difficulty breathing or swallowing, wheezing, rash or blisters, or shock.

Medication Overuse Headaches

As with many migraine prophylactic drugs, ibuprofen has been associated with a type of headache known as a medication overuse headache, or rebound headache. A medication overuse headache is one that occurs when a person takes a headache pain reliever for 10 to 15 or more days per month, depending on the medication, for more than three months.

Healthcare providers believe it's not the total dose of medication that can lead to rebound headaches, which can feel like regular migraine pain or like tension headaches, but rather how often it's taken over the course of a week.

If you're taking ibuprofen regularly and begin to get headaches frequently, see your healthcare provider. If it turns out you're having rebound headaches, stopping the ibuprofen should end them.

Interactions

Ibuprofen and similar NSAIDs are generally regarded as safe for most people to take, but there is a risk that they will interact with certain other medications.

According to a 2015 study, "adverse drug reactions, including gastrointestinal bleeding, as well as cardiovascular and renal effects, have been reported with NSAID use." The drugs most likely to interact with ibuprofen were:

• Aspirin
• Alcohol
• Antihypertensives (drugs that lower blood pressure)
• Antidepressants, including selective serotonin reuptake inhibitors and tricyclic antidepressants

Note that there may be other medications, as well as supplements or herbal remedies, that are best avoided while taking NSAIDs. If your healthcare provider prescribes ibuprofen as a migraine preventative, be sure to tell her about everything that you take.

Contraindications

There are a handful of circumstances under which ibuprofen is not considered safe to take at all:

• To relieve pain just before or right after heart surgery, such as coronary artery bypass graft surgery
• When taken as an analgesic or migraine prevention drug by someone who has a history of sensitivity to aspirin

People who have diabetes shouldn't use the suspension form of ibuprofen as it contains sugar. And anyone with a history of stroke should use ibuprofen with caution as it may make symptoms worse.