ibuprofen

5 January 2024

“Older” Migraine Meds on Trial: What Works?

James Discoveries & Stats, Medications 0

Late last year a new study analyzed almost 4.7 million migraine attacks and the medications that patients took. According to those patients, which abortive medications actually worked?

The data was collected from patients’ responses on a smartphone app between 2014 and 2020 (which is why newer medications like gepants and ditans were not included in the study). Dosage was also not taken into consideration. Finally, the “baseline” was ibuprofun. In other words, which medications worked better than (or not as well as) ibuprofen?

However, as you can see, the sample size was huge. So which medications, according to patients, really fought back against an individual migraine attack?

It shouldn’t surprise too many that the migraine-targeting meds worked best:

Triptans (e.g. eletriptan, sumatriptan, zolmitriptan) were at the top of the list, working well 5x more often than ibuprofen.
Ergots (dihydroergotamine and ergotamine) were 3x more effective than ibuprofen
Anti-emetics (anti-nausea medications) were 2.5x more effective
Next came opioids, and NSAIDs (not including ibuprofen)

This is not to say that ibuprofen isn’t effective. It was still effective 42% of the time. And it roundly beat acetaminophen (paracetamol), which was effective 37% of the time.

But other similar NSAIDs other than ibuprofen may be worth trying – especially ketorolac, which came out as working 62% of the time, significantly more than its cousin ibuprofen.

Since triptans topped the list, which triptans tended to work the best? Well, it was the ones listed above, but not in that order:

eletriptan
zolmitriptan
sumatriptan

They were all considered effective over 70% of the time – and remember, triptans very much depend on the person, and also how they’re taken.

There’s no doubt that these “older” medications, even ibuprofen, are still helping a lot of people. Lists like this won’t necessarily tell you what will work for you. However, they do give you a place to start.

Your doctor will be able to take more of your personal medical history into consideration when recommending a medication. And there are also risks and side effects to consider, which also vary from person to person.

But if you’re a candidate for a triptan, one of the top three is probably going to be high on your doctor’s list. Tylenol, on the other hand, might be best left on the drugstore shelf, until you’ve tried some better options for migraine.

For the actual study abstract, you can go to Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users’ Self-Reported Records From a Smartphone Application.

For another more detailed analysis, check out Certain Migraine Medications May Be More Effective Than Ibuprofen.

14 October 2021

A Natural Alternative to Sumatriptan? (Your Questions)

James Information, Treatments 1

Is there a good natural alternative to sumatriptan?

First, an apology – I’ve been negligent in answering your questions. So today I’m going to tackle one from Vicki in the USA.

Vicki finds that sumatriptan helps fight her migraine attacks. But she’s wondering if there’s a “natural alternative” to sumatriptan that she can use when she doesn’t have any medication available.

It’s a great question, but not an easy one! For one thing, triptan medications such as sumatriptan don’t seem to act the same in every person. And sometimes even small differences (such as the differences between a generic and a brand name medication, or different “delivery methods” – tablet, nasal spray, etc.) can make a difference in how well it works. Also, triptans may help with various symptoms (nausea, pain, sensitivity to light).

So you’re probably not going to find a precise alternative that does the exact same thing in your body.

Another reason why the question is difficult is that sumatriptan, as an older and much-studied medication, is often compared with other treatments. Some of these studies are high quality, others not. But the short story is that there are actually a lot of alternatives. Basically, most of the good alternative treatments that you’ve heard about are probably worth a try.

It may surprise many people that there are excellent, often well-studied alternatives to medications. Many people still assume that a “natural alternative” is going to be inferior. But that may not be the case at all.

So, to get back to the original question, here are some possible alternatives that you may want to try. But, as with medications, it will be trial and error, and you may need a combination of some of the treatments listed.

Water and salt – Staying hydrated is a great way to avoid migraine. But you may find that you can lesson the symptoms of an attack with some water and a salty snack. If you feel that you’ve eaten something that is triggering the attack, drinking more water may help lesson the trigger effect.
Ginger Supplement – This is one of those studies I was telling you about. In a study published in 2014, researchers found that a 250mg dose of ginger was comparable (in some ways better) than a 50mg dose of sumatriptan. Ginger has been used for pain and nausea in other conditions besides migraine.
Heat and Cold – Experimenting with heat and cold (ice and heat packs) has long been a helpful migraine treatment, but as with anything it seems to work differently depending on the person and the migraine attack.
MigreLief-Now – A combination supplement specifically designed to fight migraine when the attack is starting.
“Starve and Sink” – This method is completely counter-intuitive, but it’s becoming more well known thanks to the work of Dr. Josh Turknett. You can read more here: How To End A Migraine Without A Pill (starve and sink, part 1), and then part 2 here.

A few more things to consider. First, here’s a brief list of “natural remedy” ideas that may help.

Second, it’s important to consider overall lifestyle changes and possibly supplements that may help prevent migraine. I’m thinking about things like magnesium, cutting down on sugar (part 1 and part 2), and proper exercise.

Finally, there are other medications that you may be able to have on hand to stop an attack, and you may be surprised how effective they are (if taken very occasionally). For example, the humble aspirin and ibuprofen. Ketorolac is another example of a simple anti-inflammatory that has been compared to sumitriptan.

Have you found a natural supplement that has helped fight a migraine attack in the place of sumatriptan? Leave a comment, and let’s help Vicki by keeping the conversation going.

5 October 2020

Dexketoprofen: Why You Might Start Hearing More About It.

James Medications 0

Dexketoprofen for migraine treatment. You may have already heard of ketoprofen, a similar NSAID. Dexketoprofen is known as an “isomer” of ketoprofen, but that’s another story.

There are, of course, quite a few NSAIDs used for migraine treatment, probably the most common being ibuprofen (often sold under the brand name of Advil). Other common ones are naproxen and ketorolac.

These types of “painkillers” are used over the counter or by prescription. They’re usually taken as an “abortive” after a migraine attack has started. They’re also used when a patient is in the emergency room with migraine. Intravenous ketorolac or ibuprofen may be used in emergency room, sometimes mixed with metoclopramide for nausea.

So with so many NSAIDs out there, why bother with dexketoprofen (sometimes sold as Keral)? Well, some studies seem to indicate that dexketoprofen may work a lot faster than some other common NSAIDs.

For example, this study showed that IV dexketoprofen was working within half an hour, while ibuprofen was working well after an hour. A new study is being done in Turkey to compare the dexketoprofen/metoclopramide mix with the more common ibuprofen/metoclopramide mix.

So you may be hearing more about dexketoprofen for the treatment of migraine. We’re always looking for treatments that work faster, for obvious reasons.

For more research on dexketoprofen, check out: Systematic review of dexketoprofen in acute and chronic pain

8 May 2020

Which Medications are most recommended for Children and Teens with Migraine?

James Discoveries & Stats, Medications 0

These specific recommendations come from the American Academy of Neurology and the American Headache Society. A helpful summary was published at Practical Pain Management.

As with many such studies, the recommendations come from the level of “confidence” that we have based on the results of clinical trials. For example, as we’ll see under “preventatives”, amitriptyline (Elavil) is “high confidence” as a preventative, but propranolol (Inderol) is “low confidence”. That doesn’t necessarily mean that amitriptyline is amazing and the best or that propranolol is useless. It does mean that our data for propranolol is a lot more limited – although so far it looks quite promising.

Before even getting to medication, the article (Ask the PharmD: What are the recommendations for preventing and treating pediatric migraine?) quite rightly points to lifestyle changes. We could add to that other treatments, including biofeedback and certain supplements. It’s tempting to look at the most recommended medications and think that these are the most recommended treatments – that’s not the case. With children, as with adults, there are some excellent treatments that you’ll probably want to try before any regular medications (especially preventative medications).

So let’s start with abortive medications – which drugs are most recommended to stop a migraine attack once it’s started? Remember, this is different with every child, but at this point the most recommended include triptans – but not any triptan. Most recommended are zolmitriptan, and then sumitriptan. Also the combination of sumitriptan and naproxen. However, these are only recommended for ages 12 and up (many medications simply haven’t been adequately studied in younger children).

Ibuprofen is also recommended, and is the #1 choice for younger children (6 months and older).

Sumitriptan/noproxen and zolmitriptan were also recommended for the related symptoms of photophobia and phonophobia – that is, sensitivity to light and noise.

If the symptoms are serious and frequent, and other medications haven’t worked sufficiently, preventatives may be tried.

For preventatives, as mentioned earlier, amitriptyline was the “high confidence” choice, with topiramate sneaking in under “moderate confidence”. These were only listed for ages 10-17.

Remember, preventatives should be far down the list of things to try. Steady doses of medication and their side effects are not to be rushed into. Check this article for other reasons to be less than optimistic about preventatives for children: New Study Questions Preventative Migraine Drugs for Kids

Remember, these recommendations do not automatically mean that they’re the best choice for you or your child. If other medication has been tried but these have not, it’s probably a good place to start. But it will be worth the trouble to investigate other non-drug treatments, many of which have been very helpful for children and teens.

For more details, take a look at the article at Practical Pain Management, especially the last section.

13 December 2019

Anti-inflammatory Drugs and Ulcers

James Information 0

A common class of anti-inflammatory drugs, known as NSAIDs (nonsteroidal anti-inflammatory drugs), are common villians when it comes to developing stomach ulcers. These drugs would include aspirin and ibuprofen. So – should I be worried?

What is a stomach ulcer?

Stomach ulcers (or peptic ulcers) are sores that may develop on the lining of your stomach (gastric ulcers) or in the upper small intestine (duodenal ulcers). This occurs when acid eats away at the lining. Normally, there is a protective mucous which keeps the acid from doing any harm. But there are some things that may cause an increase in acid or a decrease in the mucous shield.

There are some interesting misconceptions about stomach ulcers. For example, your stomach is well designed to handle spicy or acidic foods, so drinking a Coke or eating that spicy salsa isn’t likely to cause an ulcer. Neither is the common excuse – stress.

However, adding more acid or spicy food to your stomach may make ulcers worse. Since many people with ulcers may have few or no symptoms, it’s easy to believe the myths that the Mexican food actually caused the ulcer itself.

But one of the causes does seem to be NSAIDs.

Why might NSAIDs cause stomach ulcers?

Essentially, NSAIDs can cause problems with the “shield” that protects your stomach lining. They affect prostaglandins, a substance in your body critical to the protection of the stomach.

Look at it this way – by introducing something foreign into your body’s system, you are able to lower inflammation for a time, but you are also interfering with your body’s natural functions.

Taking one aspirin isn’t likely to cause a problem. But high doses of NSAIDs, or continued usage, may indeed lead to peptic ulcers.

How can I avoid stomach ulcers?

Stomach ulcers are common, and you may already have them and not know it. If you start getting symptoms, see your doctor.

Your best plan of attack is simply to limit your use of NSAIDs. Although a good rare or short term solution for headache, if you find yourself taking them every week or two, you should seriously consider changing your strategy.

Also, be sure to take your NSAID with food, if possible. And consider taking an NSAID that is less likely to harm the stomach (see more information at NSAIDs – Which One Should I Take For Headache?).

You could also discuss non-NSAID options with your doctor. There are pros and cons to each medication, so the best thing to do is to at least supplement the “painkillers” with changes in lifestyle that will fight headache.

In more extreme cases, or when you really can’t avoid the NSAIDs, your doctor may recommend other medication to help with the affects of these drugs.

For more information, check out Nonsteroidal Anti-inflammatory Drugs(NSAIDS) and Ulcers.