The use of combination therapies in the acute management of migraine

Abstract

Background and objectives:Migraine is a highly prevalent neurological disorder with multiple peripheral and central mechanisms. Targeting a single mechanism for treating individual attacks as well as for performing the prophylaxis has been shown to be only partially effective. Recently, the role of combining agents for acute migraine treatment has gained attention and the combination of a triptan plus a non-steroidal anti-inflammatory drug (NSAID) has demonstrated better efficacy. This review focuses on the fundamentals of treating migraine attacks with two or more agents, and emphasizes the characteristics of the recently approved fixed combination sumatriptan-naproxen. Methods: A PubMed search using the terms "migraine", "treatment", "acute", "triptans", "non-steroidal anti-inflammatory drugs", "sumatriptan", "naproxen", and "combination" was used. In addition, abstracts presented in the major meetings of the American Headache and the International Headache Societies along with the American Academy of Neurology were also evaluated. Results: Although most of the few studies encountered were not controlled, there is a clear trend for better efficacy in combining triptans with NSAID. Additionally, the results of two recent large and controlled studies using fixed combinations of sumatriptan (50 mg and 85 mg) with 500 mg naproxen sodium confirm the initial observations of the clear superiority of this combination over the use of each agent alone. The differences in the endpoints 24-hour painrelief response as well as pain-free and pain-relief parameters at 2-hour time-point are the most noticeable efficacy measures. Tolerability was not different between studied drugs. Conclusions: Combining triptans with NSAID and other agents for the acute treatment of migraine suggests better outcome efficacy measures than the use of single agents. The fixed combination of sumatriptan and naproxen sodium offers improved 2-hour and 24-hour benefits over monotherapy with each one these options. Recently issued FDA approval for marketing the combination (sumatriptan 50 mg-naproxen 500 mg) emphasizes the usefulness and safety of this new treatment for migraine attacks.

Early (≤1-h) vs. late (>1-h) administration of frovatriptan plus dexketoprofen combination vs. frovatriptan monotherapy in the acute treatment of migraine attacks with or without aura: a post hoc analysis of a double-blind, randomized, parallel group study

“…Thus, the combination of triptan plus NSAIDs could reduce the risk of medication-overuse headaches and related adverse drug effects [11,16]. In this regard, a two-drug combination, as that between frovatriptan and dexketoprofen, ensuring both quick and sustained pain-free activity, should be regarded as a useful treatment option for migraineurs [22,23].…”

Headache Research and Medical Practice in Brazil: An Historical Overview

“…Ribeirão Preto School of Medicine‐USP's main contributions are on pharmacology of pain mechanisms, epidemiological studies, and clinical research on the relationship between primary headaches and temporo‐mandibular joint disorders; Universidade Federal Fluminense (Niteroi) is notable for its studies on chronic daily headache and psychiatric comorbidities and headache in the elderly. Abouch Krymchantowski obtained his MSc and PhD at this university and has published a number of papers in the area of headache . Universidade Federal do Rio de Janeiro , for its part, researches spreading depression in chicken retina and neuroimaging.…”

“…In Rio de Janeiro, São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul, there are several centers dealing with headache disorders and an excellent scientific production has been made by a number of headache specialists, mentioning Abouch Krymchantowski, Carla da Cunha Jevoux, Maurice Vincent, Pedro Ferreira Moreira Filho, Jano Alves de Souza, Maria Eduarda Nobre in Rio de Janeiro; Celia P. Roesler, Deusvenir de Souza Carvalho, Eliova Zukerman, Mario Fernando Prieto Peres,…”

The Comparıson Of Trıptans, Nsaıd Or Combınatıon On Mıgraıne Attack Treatment

“…[5][6][7] Migrene özgü olmayan tedavi seçenekleri arasında yer alan NSAİİ uzun etki süreleri ve allodiniye yöne-lik tedavi spektrumlarıyla tercih edilmektedir. [8] Tenoksikam uzun yarılanma ömrüne sahip (60 saat) bir NSAİİ'dir. COX1'e daha seçici inhibisyon göstererek prostaglandin sentezini azaltır.…”