In a systematic review and meta-analysis, both Paracetamol and Ibuprofen demonstrated superior effectiveness compared to a placebo in addressing episodic tension-type headaches (ETTH). The aim was to compare Paracetamol Vs Ibuprofen in treating ETTH. Searches were carried out on Web of Science, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE. Fourteen randomized controlled trials including 6521 people with ETTH were recorded.

The risk of bias was evaluated utilizing the Cochrane Collaboration risk of bias tool. All the studies lacked a low risk of bias in all domains, primarily attributed to insufficient reporting and a limited sample size. In terms of pain-free status at 2 hours, Ibuprofen displayed superior efficacy compared to Paracetamol, whereas Paracetamol exhibited better efficacy than Ibuprofen at 1 hour, as illustrated in Table 1.

Paracetamol was linked with the lowest likelihood of rescue medication usage (OR: 0.49, 95% CI 0.37-0.65). Ibuprofen was related to a lower likelihood of the occurrence of any events and gastrointestinal adverse events in comparison with placebo and paracetamol (OR: 0.95, 95% CI 0.64-1.41 and OR: 0.81, 95% CI 0.44-1.50, respectively).

Both Paracetamol and Ibuprofen illustrated greater efficacy than a placebo in addressing ETTH, and there was no notable distinction in effectiveness between the two. In cases where individuals face elevated risks, such as renal insufficiency or gastrointestinal bleeding, Paracetamol might be the preferred choice over Ibuprofen.