Aborting a Migraine Attack: Naproxen Sodium v Ergotamine plus Caffeine

Abstract

The tolerability and efficacy of naproxen sodium and of ergotamine tartrate plus caffeine (ergotamine) were compared in the treatment of acute migraine attacks and associated symptoms. In this multicenter, double-blind, parallel study of up to six headaches over a 3-month period, patients took naproxen sodium 825 mg, ergotamine 2 mg, or placebo at the time of the first symptom of an attack; 30 minutes later, if necessary, patients repeated naproxen sodium 275 mg, ergotamine 1 mg or placebo, as appropriate. Rescue medication was allowed 30 minutes following the second dose if needed. Active drugs provided notably better relief of head pain than did placebo; 1 hour following the first dose the difference between naproxen sodium and placebo was statistically significant. Naproxen sodium was as efficacious as ergotamine in the relief of migraine attacks and associated symptoms. Relief of vomiting, nausea, photophobia, and motor symptoms favored naproxen sodium over ergotamine; these differences were statistically significant for nausea and motor symptoms. Ergotamine-treated patients reported more complaints and had more severe and longer-lasting complaints than patients on the other two regimens. Overall tolerance ratings by both investigators and patients indicated that naproxen sodium and placebo were tolerated significantly better than ergotamine.

NSAIDs in the Acute Treatment of Migraine: A Review of Clinical and Experimental Data

“…As expected from earlier studies [87,123], tolerability of NSAIDs was superior to that of ergotamine in several trials [62,84,100,111,112,113], while efficacy was similar. Ergotamine caused more nausea and vomiting, although this was statistically significant only in two trials [84,111].…”

“…One trial showed some superiority of naproxen sodium over an ergotamine combination [111] but in other studies equal effects were found for naproxen sodium and ergotamine [112] or ergotamine + caffeine [113]. …”

Comparative Efficacy and Safety of Calcium Carbasalate plus Metoclopramide versus Ergotamine Tartrate plus Caffeine in the Treatment of Acute Migraine Attacks

“…The percentage of adverse events with EC was lower than the rate observed in studies with 2 mg ET: 39% [20], 41% [15]and 64% [16]. Moreover, 0.7% of the patients withdrew from our study in the EC group compared with 3% [17]and 5% [21]in the literature. Statistically more gastrointestinal adverse events occurred with EC.…”

“…Only in one study of CM versus oral dihydroergotamine were the efficacy rates higher than in our study; 64% for success, of which 41% of the patients were cured [13]. In the literature, some studies have looked at the efficacy of EC at a 2-mg dose [14, 15, 16, 17, 18, 19, 20]or of ET alone [21]. However, in all except three [16, 19, 20], the number of patients was low.…”

Management of headaches

“…A recent multicenter trial has demonstrated that the nonsteroidal anti-inflammatory drug (NSAID) naproxen sodium (Anaprox), in a single dose of 825 mg, is as effective as ergotamine in relieving migraine headache pain and its accompanying symptoms. 4 At the Diamond Headache Clinic, Chicago, we have observed that the use of the NSAID ketoprofen (Orudis), 75 mg at onset of the headache, continued A recent multicenter trial has demonstrated the efficacy of an NSAID in relieving migraine headache pain and its accompanying symptoms. has been similarly effective in aborting migraine attacks.…”