Sumatriptan-naproxen fixed combination for acute treatment of migraine: a critical appraisal

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen and naproxen sodium, are effective yet nonspecific analgesic and anti-inflammatory drugs, which work for a variety of pain and inflammatory syndromes, including migraine. In migraine, their analgesic effect helps relieve the headache, while their anti-inflammatory effect decreases the neurogenic inflammation in the trigeminal ganglion. This is the hypothesized mechanism by which they prevent the development of central sensitization. Triptans, including sumatriptan, work early in the migraine process at the trigeminovascular unit as agonists of the serotonin receptors (5-HT receptors) 1B and 1D. They block vasoconstriction and block transmission of signals to the trigeminal nucleus and thus prevent peripheral sensitization. Therefore, combining these two drugs is an attractive modality for the abortive treatment of migraine. Sumatriptan–naproxen fixed combination tablet (Treximet® [sumatriptan–naproxen]) proves to be an effective and well tolerated drug that combines these two mechanisms; yet is far from being the ultimate in migraine abortive therapy, and further research remains essential.

Identification of Cytokines and Signaling Proteins Differentially Regulated by Sumatriptan/Naproxen

“…Based on clinical observations on the temporal response to these drugs on migraine, sumatriptan/naproxen is proposed to function primarily at the level of the ganglia to abort a migraine attack. 37, 38 Our findings support such a notion. In this way, sumatriptan and naproxen repression of cytokines and signaling protein levels within the ganglia, as seen in our study, would suppress the development of peripheral sensitization of primary nociceptors, and hence limit the later development of central sensitization.…”

Indomethacin/Prochlorperazine/Caffeine

“…[5] TTH may be treated with effective over-thecounter analgesic agents and the amelioration of any circumstances that may be triggering the headaches or causing the patient concern. [6,33] For instance, the efficacy of simple analgesics and NSAIDs is improved with the coadministration of caffeine, [4] with concomitant therapy with a NSAID and an antiemetic potentially providing relief from migraine-associated nausea and facilitating absorption. aspirin, paracetamol) or NSAIDs, the mainstays in episodic TTH therapy.…”

The Efficacy of Propofol vs. Subcutaneous Sumatriptan for Treatment of Acute Migraine Headaches in the Emergency Department: A Double‐Blinded Clinical Trial

“…Although triptans have been introduced as a safe and effective treatment for migraine attacks, this class of drugs has well‐known side effects and contraindications including chest pressure, neck tightness, limb heaviness, and tingling. Contraindications include vascular disease, coronary artery disease, and pregnancy . Several open‐label studies and case reports and one double‐blinded study have shown that subanesthetic doses of propofol are efficacious as rescue therapy for acute migraine headaches in adults and children .…”