Which medications in the drug class Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used in the treatment of Cluster Headache?

Updated: Jun 07, 2019
  • Author: Michelle Blanda, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) may alleviate headache pain by inhibiting prostaglandin synthesis, reducing serotonin release, and blocking platelet aggregation. Although their effective in the treatment of headache pain tends to be patient-specific, ibuprofen is usually the drug of choice for initial therapy. Other options include naproxen, ketoprofen, flurbiprofen, indomethacin, and ketorolac.

Ibuprofen (Motrin, Advil, Addaprin, Caldolor)

Ibuprofen is the drug of choice for mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Many doses are available, either with or without a prescription.

Ketoprofen

Ketoprofen is used for the relief of mild to moderate pain and inflammation. Small doses are indicated initially in patients with small body size, elderly patients, and persons with renal or liver disease. Doses of over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.

Naproxen (Anaprox, Naprelan, Aleve, Naprosyn)

Naproxen is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

Flurbiprofen

Flurbiprofen may inhibit cyclooxygenase, thereby inhibiting prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Indomethacin (Indocin)

Indomethacin is absorbed rapidly; it is metabolized in the liver via demethylation, deacetylation, and glucuronide conjugation. It is useful in the diagnosis of CH because it helps other headache syndromes (eg, chronic paroxysmal hemicrania).

Ketorolac

Ketorolac inhibits prostaglandin synthesis by decreasing the activity of cyclooxygenase, thereby resulting in decreased formation of prostaglandin precursors.

Ketorolac nasal solution (Sprix)

Ketorolac inhibits cyclooxygenase, an early component of the arachidonic acid cascade, resulting in reduced synthesis of prostaglandins, thromboxanes, and prostacyclin. It has anti-inflammatory, analgesic, and antipyretic effects and is indicated for short-term (≤ 5 days) management of moderate to moderately severe pain. The bioavailability of a 31.5-mg intranasal dose (2 sprays) is approximately 60% of that of a 30-mg IM dose. The intranasal preparation delivers 15.75 mg per 100-µL spray; each 1.7-g bottle contains 8 sprays.


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