Indomethacin Responsive Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of 81 Published Clinical Studies

Abstract

The "velocity" of publications on IMC and headache seems to be decreasing, particularly on the use of IMC for the treatment of TACs. The science behind the understanding of the putative mechanisms of IMC's action on headache has moved forward, but the answer to why it works better than other nonsteroidal anti-inflammatory drugs has been elusive. There are case reports of other rare headache disorders that may be responsive to IMC. The dosages of IMC used as a tool for detecting IMC responsive disorders vary according to different centers of investigation. In many circumstances, headache disorders similar to "primary" IMC-responsive disorders are actually symptomatic disorders. Cluster headache as an IMC-resistant headache disorder may not be as absolute as once thought. Sometimes, IMC has been found to provoke headache; differentiating IMC-provoked headache from IMC-resistant headache can make headache diagnosis and management difficult. As for the "absolute" responsiveness of IMC, it is possible that using higher dosages leads to higher sensitivity, probably at the expense of decreased specificity. There are many reports about the occurrence of two or more IMC-responsive disorders (latu sensu) in the same patient, which may be coincidental.

RANZCP Abstracts

“…Some patients report improvement with a cup of coffee before sleep (Diener et al, 2012) or that drinking a cup of black coffee before bed is effective in treating headaches (Holle and Obermann, 2012;Mathew and Wilson, 1985) Indomethacin is useful if the headache is unilateral (Diener et al, 2012;Dodick, 2004;Patsouros et al, 2004;Pinessi et al, 2003). Lithium appears to be the most effective treatment option, which has been associated with increased plasma levels of melatonin (Bordini et al, 2016;Chazot et al, 1987;Dodick, 2000;Treiser et al, 1981). Melatonin deficiency may explain the occurrence of hypnic headaches in biologically predisposed subjects (Dodick et al, 1998).…”

Case report of hypnic headache: a rare headache disorder with nocturnal symptoms

“…Cluster headache). Why indomethacin is better in headache management than other non-steroidal anti-inflammatory drugs remains unclear [7,8]. A recent case report described improvement of hypnic headache with greater occipital nerve block when all pharmacological options failed [9].…”

Indometacina: uma visão bioquímica

“…Devido às suas propriedades antiinflamatórias, analgésicas e antipiréticas, é indicado no tratamento de dores agudas, condições inflamatórias como dores pós-operatórias, dores de origem dentária, cólicas menstruais, dores associadas a doenças reumáticas (Nalamachu, Wortmann, 2014). A indometacina também é utilizada no tratamento de enxaquecas, especialmente nas cefaleias indometacina-responsivas, que são um grupo heterogêneo de doenças que respondem completa ou parcialmente ao tratamento com a indometacina (Bordini, Bordini, Woldeamanuel, Rapoport, 2016). O script produzido para a Figura 5 está apresentado no Capítulo 11 -Scripts desenvolvidos.…”