Diclofenac with or without an antiemetic for acute migraine headaches in adults

Abstract

Background This review is an update of a previously published review in Issue 2, 2012 (Derry 2012a). Migraine is a common, disabling condition and a burden for the individual, health services and society. Many sufferers choose not to, or are unable to, seek professional help and rely on over-the-counter (OTC) analgesics. Diclofenac is an established analgesic, and new formulations using the potassium or epolamine salts, which can be dissolved in water, have been developed for rapid absorption, which may be beneficial in acute migraine. Co-therapy with an antiemetic should help to reduce the nausea and vomiting commonly associated with migraine. Objectives To determine the efficacy and tolerability of diclofenac, alone or in combination with an antiemetic, compared to placebo and other active interventions in the treatment of acute migraine headaches in adults. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Oxford Pain Relief Database, ClinicalTrials.gov, and reference lists for studies through 27 September 2011 for the original review and 15 February 2013 for the update. Selection criteria We included randomised, double-blind, placebo-controlled or active-controlled studies, or both, using self administered diclofenac to treat a migraine headache episode, with at least 10 participants per treatment arm. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used numbers of participants achieving each outcome to calculate relative risk (or 'risk ratio') and numbers needed to treat to benefit (NNT) or harm (NNH) compared to placebo or a different active treatment. Main results Five studies (1356 participants, 2711 attacks) compared oral diclofenac with placebo, and one also compared it with sumatriptan; none combined diclofenac with a self administered antiemetic. Four studies treated attacks with single doses of medication, and two allowed an optional second dose for inadequate response. Only two studies, with three active treatment arms, provided data for pooled analysis 1 Diclofenac with or without an antiemetic for acute migraine headaches in adults (Review)

Acute Migraine Treatment in Adults

“…9 NSAIDs.-The NSAIDs are generally a good starting point for acute migraine treatment, although acetaminophen can be tried if there are contraindications to NSAID use, and triptans are another option. Ibuprofen, 10 naproxen sodium, 11 acetylsalicylic acid (ASA), 12 and diclofenac potassium 13 all have double-blind randomized controlled trial evidence for efficacy that has been analyzed in systematic reviews. These NSAIDs have different pharmacokinetics, and this has implications for their usefulness in a specific patient.…”

“…11,19 Pharmacokinetics, dosages, and headache response rates (given as NNTs [number needed to treat]) for acetaminophen and the NSAIDs are shown in Table 1. 5,9,12,13,18,19 Combination analgesics with both acetaminophen and ASA have also been investigated for efficacy in acute migraine treatment. A combination of acetaminophen, ASA, and caffeine has been shown to have greater efficacy than any one of its components in comparable doses alone.…”

Progress in the Treatment of Migraine Attacks: From Traditional Approaches to Eptinezumab

“…A Cochrane systematic review and its update have demonstrated that ibuprofen confers relief in half of the population, but the complete disappearance of headache pain and symptoms only in a minority of migraineurs [10,11]. Additionally, diclofenac provides pain-free time only in a minority of patients [12]. Aspirin has resulted effective for acute migraine sufferers, but for the reduction of the symptoms nausea and vomiting the addition of metoclopramide 10 mg is useful [13,14].…”

Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children

“…This drug is readily absorbed from the alimentary tract, and its half time is about one to two hours, and it will quickly dissolve in an environment with a pH higher than five. Diclofenac as one of the most potent NSAID has a few side effects when administered rectally ( 10 ). Antipyretic effects of this drug have received less attention in comparison with its analgesic effects ( 11 , 12 ).…”