title: Use of Nonsteroidal Anti-Inflammatory Drugs for Symptomatic Treatment of Episodic Headache.
abstract: Primary headaches have high epidemiologic impact but their symptomatic treatment often remains problematic. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used, but their modality of employment and efficacy/differential efficacy are highly variable. This study investigated current NSAID use for episodic headache at an Italian headache center (January 2000 to February 2013).
  
  
  
  A retrospective evaluation was performed on 6,443 patient records: migraine (n = 2,330), tension-type headache (TTH; n = 807), and migraine plus TTH (n = 3,306).
  
  
  
  Among migraine patients, 80% had used NSAIDs in the past year. Preferences were: nimesulide (57%), ketoprofen (25%), and ibuprofen (24%); complete efficacy was significantly higher than incomplete/absent efficacy (P < 0.0001). NSAIDs were replaced with triptans in 53% of patients at first visit; after 1 year there was a spontaneous significant return to NSAIDs (56%; P < 0.0005). Among TTH patients, 90% were NSAID users; preferences were: nimesulide (48%), ketoprofen (47%), and diclofenac (19%), with significantly higher complete vs. incomplete/absent efficacy (nimesulide and ketoprofen, P < 0.02). Replacement with analgesics was performed in 24% of patients; after 1 year, there was a 29% return to NSAIDs. Among migraine plus TTH patients, 89% were NSAID users. Preferences were: nimesulide (44%), ibuprofen (42%), and ketoprofen (38%), with significantly higher complete vs. incomplete/absent efficacy (0.001 < P < 0.0001). Replacement with analgesics was performed in 31% of patients; after 1 year, there was a 37% return to NSAIDs.
  
  
  
  Nonsteroidal anti-inflammatory drug use in headache was higher than could be hypothesized based on guidelines, with NSAID preferences not entirely coinciding with international recommendations. This outcome suggests the need for greater awareness of all treatment options in headache by both patients and physicians.
authors.affiliation: Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-MeT, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Giannapia
authors.initials: G
authors.lastname: Affaitati
authors.affiliation: Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, "Sant'Andrea" Hospital, "Sapienza" University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Martelletti
authors.affiliation: Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-MeT, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Lopopolo
authors.affiliation: Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tana
authors.affiliation: Institute of Clinical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Massimini
authors.affiliation: Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-MeT, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cipollone
authors.affiliation: Department of Medicine and Science of Aging, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Lapenna
authors.affiliation: Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-MeT, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Maria Adele
authors.initials: MA
authors.lastname: Giamberardino
authors.affiliation: Institute of Surgical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Costantini
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D013449:Sulfonamides / Q000627:therapeutic use; D016896:Treatment Outcome; D014363:Tryptamines / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013449:Sulfonamides; D014363:Tryptamines; D004008:Diclofenac; C012655:nimesulide
keywords: episodic headache; migraine; nonsteroidal anti-inflammatory drugs; symptomatic treatment; tension-type headache