Which medications in the drug class Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used in the treatment of Chronic Paroxysmal Hemicrania?

Updated: Jun 12, 2019
  • Author: Monica Saini, MD, MBBS; more...
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Answer

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Indomethacin (Indocin)

Indomethacin has absolute effect on symptoms of CPH. It is available as an immediate-release preparation, a sustained-release preparation, a suppository, and an oral suspension.

Naproxen sodium (Aleve, Anaprox, Naprelan, Naprosyn)

Naproxen sodium is used for the relief of mild to moderately severe pain. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

Ibuprofen (Motrin, Ibuprin, Addaprin, Ibu, Caldolor)

Ibuprofen is the drug of choice for patients with mild to moderately severe pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Piroxicam (Feldene)

Piroxicam is used for the relief of mild to moderately severe pain. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

Celecoxib (Celebrex)

Celecoxib primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient. It is extensively metabolized in liver primarily via cytochrome P450 2C9. Celecoxib is approved by the FDA to treat osteoarthritis and rheumatoid arthritis.

Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.

Aspirin (Ascriptin, Bayer Aspirin, Bufferin, Ecotrin, Halfprin)

Aspirin treats mild to moderately severe pain. It inhibits prostaglandin synthesis, preventing the formation of platelet-aggregating thromboxane A2.


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