Role of NSAIDs in Migraine Management

NSAIDs or non steroidal anti inflammatory drugs have and play a very important role in treatment/management of migraine headache, especially in mild migraine. Commonly used non steroidal anti inflammatory drugs in migraine are naproxen (at the dose of 220 to 550 mg orally two times a day), ibuprofen (at the dose of 400 mg every 3 to 4 hourly), tolfenamic acid (at the dose of 200 mg, the dose can be repeated after 1 to 2 hours) etc.

Non steroidal anti inflammatory drugs (NSAIDs) can reduce the duration of acute migraine attack significantly as well as the severity of the attack. In fact many patients with headache (but not diagnosed as migraine) treat themselves with over the counter (nonprescription) non steroidal anti inflammatory drugs.

In general and everybody accepts it, that the non steroidal anti inflammatory drugs are most useful if taken early in the migraine attack (the earlier the better). But it is also true that the effectiveness of anti-inflammatory agents (non steroidal anti inflammatory drugs) in migraine is usually less than optimal, especially in moderate to severe migraine attacks.

USFDA approves combination of acetaminophen (paracetamol), aspirin, and caffeine for treatment of mild to moderate migraine attacks. The combination of aspirin and metoclopramide (a dopamine antagonist) is also effective in migraine attacks (equally effective as sumatriptan).

Disadvantages of NSAIDs:

The disadvantage of non steroidal anti inflammatory drugs is the side effects of these drugs. The common side effects of non steroidal anti inflammatory drugs are dyspepsia and gastrointestinal irritation, which can lead to gastrointestinal ulceration. To minimize these side effects of NSAIDs, they should be taken with food, which may limit the use of these agents in migraine.