Arcoxia and Migraine: Risks?

Recently some doctors have been prescribing Arcoxia (etoricoxib) for migraine.  But what’s the story behind this treatment?

Etoricoxib (brand names Arcoxia or Algix, Tauxib and Nucoxia) is a COX-2 selective inhibitor, a type of non-steroidal anti-inflammatory drug (NSAID).

COX-2: A brief history

COX-2 inhibitors were introduced to the public beginning in 1999.  It was hoped that the new type of NSAID would be easier on the stomach, as other NSAIDs such as ibuprofen can cause gastrointestinal issues.

But COX-2 inhibitors caused a storm of controversy, particularly in 2004-2005, and many were pulled off the market.  The concern was that the new drugs increased the risk of “cardiovascular events” – a particular concern for migraineurs, who already have an increased risk.

However, the risks varied depending on which COX-2 inhibitor was used.  There were also questions about risk vs. benefit in certain patients, and differences depending on dose and how long the patients took the drug.

Generally speaking, though Arcoxia was still suspect, it either didn’t raise the risk of heart problems at all or else raised the risk less than other COX-2 inhibitors such as Bextra (valdecoxib) and Vioxx (rofecoxib).

Today, Arcoxia is used in many countries around the world, though not in the United States, where the FDA has not received the data it requires to issue approval.  COX-2 inhibitors, including Arcoxia and Celebrex (celecoxib) are used in the treatment of headache and migraine, though it is still recommended that patients take the lowest dose possible for the shortest time possible.

Arcoxia and headache

Like other NSAIDs, Arcoxia is used to cut down pain and inflammation.  So it can be used like other NSAIDs depending on the patient.  There has been a special interest in using Arcoxia to prevent headache due to religious fasting (known often as “First of Ramadan Headache” or “Yom Kippur Headache”).  Patients take a dose right before fasting begins.  (See this study from 2011 and this from 2010.)

Arcoxia and Migraine

There is increased interest in using Arcoxia for migraine.  COX-2 inhibitors have been used as abortives, as short term correctives (ie taken for 10 days to break a cycle) or in some cases as a preventative.  There is also discussion about using an infusion of a COX-2 inhibitor to fight migraine, and this treatment has been used successfully in some cases.

Although etoricoxib helps to kill pain and fight inflammation, it may have unique benefits in migraineurs, fighting other symptoms.  A study last month suggested that COX-2 gene variants may raise the risk of migraine (see Cox-2 gene variants in migraine. )

Arcoxia and Migraine: Key Considerations

So if you’re thinking about trying Arcoxia for migraine, what are some of the things you should think about?

• Discuss the benefits and risks with a doctor who knows your medical history (particularly history of heart conditions, liver or kidney disease).  COX-2 inhibitors have some unique properties – for example, patients from some racial groups absorb significantly more of the medication than others.  Discuss the dosage that is right for you, not just what it says on the bottle.
• Make sure your doctor knows about other medications and supplements you may be taking.  Be sure to especially mention:  warfarin, medications related to heart conditions, lithium, hormone replacement therapies, magnesium, aspirin, and other NSAIDs.
• Once again, do discuss heart risks with your doctor.  If you have a cardiologist, it would be wise to speak to her specifically.
• Take Arcoxia with a glass of water, preferably at the same time each day.
• Consider taking Arcoxia short-term, as a part of an overall treatment plan.
• Arcoxia should not be taken during pregnancy.

Read more on Arcoxia here.  More about COX-2 inhibitors in general here.