Which medications in the drug class Nonsteroidal Anti-inflammatory Agents (NSAIDs) are used in the treatment of Childhood Migraine Variants?

Updated: Nov 19, 2019
  • Author: Wendy G Mitchell, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Answer

Nonsteroidal Anti-inflammatory Agents (NSAIDs)

NSAIDs are most commonly used to relieve mild to moderate pain. Although their efficacy in treating pain tends to be patient-specific, ibuprofen is usually the drug of choice for initial therapy. Ibuprofen, sodium naproxen, or other NSAIDs, particularly if combined with or preceded by an antiemetic, may abort acute episodes.

Ibuprofen (Ibuprin, Advil, Motrin)

Ibuprofen inhibits pain, probably by decreasing the activity of the enzyme cyclooxygenase, thereby inhibiting prostaglandin synthesis. In randomized trials, ibuprofen is one of the only agents with proven efficacy in pediatric migraine.

Indomethacin (Indocin)

Inhibition of prostaglandin synthesis reduces the delivery of solute to distal tubules, reducing urine volume and increasing urine osmolality. Indomethacin is usually used in nephrogenic diabetes insipidus.

Naproxen (Anaprox, Naprelan, Naprosyn)

Naproxen is well-absorbed orally and is not usually associated with rebound headaches. It is used for the relief of mild to moderate pain. Naproxen inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis. It is inexpensive and can be purchased over the counter.

Diclofenac (Voltaren, Cataflam XR, Zipsor, Cambia)

Diclofenac inhibits prostaglandin synthesis by decreasing cyclo-oxygenase activity, which, in turn, decreases the formation of prostaglandin precursors.

Ketoprofen

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

Ketorolac (Sprix)

Ketorolac is indicated for short-term (up to 5 d) management of moderate to moderately severe pain. The bioavailability of a 31.5-mg intranasal dose (2 sprays) is approximately 60% of 30-mg IM dose. Intranasal spray delivers 15.75 mg per 100-µL spray; each 1.7-g bottle contains 8 sprays.


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