Comment: The quality of evidence is downgraded by indirectness (suboptimal dosing) and imprecise results (few trials in each comparison).
A Cochrane review [Abstract] 1 included 4 studies with a total of 1253 subjects. They all had a frequent episodic tension-type headache (TTH) using the IHS diagnostic criteria. Useful information was available only for ketoprofen 25 mg. For the IHS preferred outcome (being pain-free at 2 hours) the NNT for ketoprofen 25 mg vs. placebo was 9.0 (95% CI 4.8 to 72; 2 studies, n=272). The NNT was 3.7 (95% CI 2.6 to 6.3) for pain-free or mild pain at 2 hours (2 studies, n=272). Fewer people needed rescue medication with ketoprofen 25 mg than with placebo, with a NNT to prevent one event (NNTp) of 6.2 (95% CI 4.3 to 11; 3 studies, n=605). The number of participants reporting any adverse event was higher with ketoprofen 25 mg than placebo (NNH 15, 95% CI 8.7 to 45; 3 studies, n=651). Ketoprofen 25 mg was not different from paracetamol 1000 mg (RR for pain-free at 2 hours 1.3, 95% CI 0.9 to 2.0; 2 studies, n=276). The number of participants reporting any adverse event was higher with ketoprofen than with paracetamol (NNH 17, 95% CI 8.9 to 130; 2 studies, n=582 participants).Studies reported no serious adverse events.
Due to the small dose of ketoprofen in the included trials its' efficacy might have been suboptimal and could have been better with optimal dosing. The same applies also to the comparison with paracetamol.
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