Non‐Steroidal Anti‐Inflammatories for the Acute Treatment of Migraine

Abstract

Nasal ketorolac or SPRIX is FDA approved for the more general category of moderate to severe pain. It is not specifically FDA approved for migraine, but does bypass the GI tract for patients who are vomiting. Treating migraines fast is very important, not only for more rapid relief, but also because as the migraine progresses, the patient's gut becomes more sluggish and less effective at absorbing pills or even melt formulations. For this reason non-tablet treatment is one way to get faster and more effective relief. As of now, the only FDA approved prescription NSAID for the treatment of migraine specifically is Cambia, a dissolvable diclofenac. It comes in the form of a flavored powder that is poured into a small amount of water, and then drunk. Other prescription NSAIDs are not FDA approved for migraine. Cambia consists of 50 mg of diclofenac, an NSAID that at 2 hours into migraine, has been shown to be as effective as the tablet form of sumatriptan, the most commonly used triptan. Unlike the generic tablet of diclofenac, Cambia begins to give pain relief in 15 minutes. In Summary: Use of an NSAID with or without a triptan, offers fast relief, does not constrict arterial blood flow, provides additional relief of inflammation, is effective late into a migraine attack, is helpful in reversing the pain spread called central sensitization, and can be especially helpful for menstrual migraine.