Diagnosis and acute management of migraine

The recommendation of naproxen is from the guideline/article (see reference below, attn: to page Supp 3, S 27 and S 29) Recommendation from the Canadian Headache Society (2012) is based on level of evidence and safety. If there are sufficient RCTs (>2) to support the efficacy of a treatment option, it has high quality evidence. If the safety profile is favorable (expert opinion), it will deserve a high recommendation from the group. The Canadian Headache Society is currently updating the guideline for migraine treatment hence hopefully it will incorporate the newer treatment option including combination sumatriptan with naproxen compound which most likely deserve high recommendation based on efficacy and safety. Naproxen on its own may have a different recommendation with future guideline - to be determined.

As for the specifics from this Cochrane review, I disagree with the final statement -"Naproxen is not a good drug for treating migraine at the doses of 500 mg or 825 mg used in the studies we found". To label a drug to be good or not good, it is important to consider both the efficacy and safety profile of the drug which is important in migraine treatment.