Which medications in the drug class NSAIDs are used in the treatment of Migraine Headache?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

NSAIDs

NSAIDs inhibit COX, an early component of the arachidonic acid cascade, resulting in reduced synthesis of prostaglandins, thromboxanes, and prostacyclin. They elicit anti-inflammatory, analgesic, and antipyretic effects. NSAIDs are generally used as abortive therapy in mild to moderately severe migraine headaches. However, these agents, especially ketorolac, may also be effective for severe headaches.

NSAIDs are also used as prophylactic agents, but they are associated with a higher risk of adverse effects, particularly gastropathy or nephropathy, than when they are used as abortive medications.

Ketorolac intranasal (Sprix)

Ketorolac is indicated for short-term (up to 5 days) management of moderate to moderately severe acute pain requiring analgesia at the opioid level. The bioavailability of a 31.5-mg intranasal dose (2 sprays) is approximately 60% of the 30-mg intramuscular dose. Intranasal spray delivers 15.75 mg per 100-µL spray; each 1.7-g bottle contains 8 sprays. Onset of analgesia is within 20 minutes, and time to peak is 0.5-0.75 hours.

Ibuprofen (Motrin, Advil, Neoprofen, Caldolor, Addaprin, EnovaRx-Ibuprofen, Goodsense Ibuprofen Children's, I-Prin, IBU-200, Ibuprofen Comfort Pac, NeoProfen, Provil))

Ibuprofen is used for the treatment of mild to moderate pain if no contraindications are present. It inhibits inflammatory reactions and pain, probably by decreasing the activity of the enzyme COX, resulting in prostaglandin synthesis.

Naproxen (Naprosyn, Naprelan, Anaprox, Aleve, Midol Extended Relief, All Day Relief, Anaprox, EC-Naprosyn, EnovaRX-Naproxen, Equipto-Naproxen, Flanax Pain Relief, GoodSense Naproxen Sodium, Mediproxen, Naprelan, Naproderm,)

Naproxen is used for relief of mild to moderate pain, as an abortive agent, and for prophylaxis. It inhibits inflammatory reactions and pain by decreasing the activity of the enzyme cyclo-oxygenase, resulting in prostaglandin synthesis.

Ketoprofen (Active-Ketoprofen, Ketophene Rapidpaq)

Ketoprofen reversibly inhibits COX-1 and COX-2 enzymes. It is indicated for mild to moderate pain. Administer small dosages initially to patients with small body size, elderly patients, and patients with renal or liver disease. Doses above 75 mg do not have increased therapeutic effects. Administer high doses with caution, and closely observe the patient for response.

Aspirin (Acetylsalicylic acid, ASA, Bayer Advanced Aspirin)

Aspirin is a mild analgesic that can be used to treat infrequent migraine episodes.


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