ketorolac

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

19 November 2018

Changing Treatments in Emergency

James Medications, Treatments 0

Treating migraine in the emergency room of a hospital is a challenge, and opinions and methods are changing rapidly. Narcotics were once common, but researchers began to discover that patients taking narcotics in emergency (instead of other treatments – more on that in a moment) actually tended to be in the hospital longer and come back more often. This isn’t to suggest that they were “drug seekers”, but simply that the narcotics were less effective than was once believed – and side effects were more common.

Changes in the emergency department — Photo credit: bidgee

As our knowledge of migraine treatment has expanded, many other treatments have become commonly available. More and more, treatments are being given such as – hydration with magnesium (intravenous), sumatriptan, NSAIDS (such as ketorolac or diclofenac), and dopamine antagonists such as metoclopramide (for nausea and other gastric problems).

And older medication, dihydroergotamine, has been persistently used as well.

A meta study published this month in the American Journal of Emergency Medicine highlighted some of these changed (see link at bottom of this article). Comparing how things were at the turn of the millennium, the study found:

Dopamine antagonists are now used 3-4 times more often
intravenous fluids used over 6x more often
Dexamethasone (a corticosteroid) used 22% more (this one is quite new – and it seems to help keep migraine from returning in the short term)
Ketorolac used 7-8x more often (also somewhat new in emergency)

Narcotics are only give 1/3 as often as they were. Not only that, “discharge prescriptions” are down to a third or less or what they were.

An obvious question is – are the new procedures helping? That may be a complex question, but the same study did find that return-to-emergency rates were also down, to a third of what they were back in 1999-2000.

That return rate may not be quite as great as it sounds – only 12% returned before, now only 4%. Still, a significant difference.

For more on emergency room procedures, see:

5 May 2016

Occasional but Terrible Migraine Attack? You might want to try Sprix.

James Discoveries & Stats, Medications, Tips 0

New research is confirming the benefits of a medication that can fight episodic migraine. It might be just the thing to try if you haven’t had success with the medications your doctor has prescribed up to this point.

Many migraine patients are familiar with Toradol, or ketorolac tromethamine. Ketorolac is actually one of the top recommended drugs to give a migraine patient in emergency. It’s low on side effects and high on effectiveness.

Today, ketorolac is available as a nasal spray – perfect for those trying to avoid injections but who still want something that’s fast-acting. The nasal spray is commonly sold under the brand name Sprix.

The Battle of the Nasal Sprays But how does this medication compare to migraine-specific medications, such as the ever-popular sumatriptan?

A study in the journal Headache this past February attempted to answer the question, pitting ketorolac nasal spray against sumatriptan nasal spray.

In a double-blind study of 72 randomized participants were treated for 152 migraine attacks.

The results? Ketorolac was every bit as good as sumatriptan – in fact, in some ways it had the edge. The pain relief seemed to last longer, and ketorolac was better at fighting nausea. It also helped fight photophobia, that painful sensitivity to light that many migraine patients experience.

More good news – none of the patients, taking either of the two medications, withdrew from the study due to side effects.

These things make a nasal spray such as Sprix very attractive for those with episodic migraine.

However, ketorolac is not recommended for chronic migraine. It is intended for very occasional use. There are cardiovascular and gostrointestinal risks if the medication is taken frequently, or if it’s taken constantly for more than a few days (read more here). For migraine patients who already may be at increased risk in these areas, frequent use of ketorolac should be avoided.

But those with episodic, or more occasional, migraine still face another hurdle. This medication can be very expensive. However, Dr. Alexander Mauskop from the New York Headache Clinic has an excellent suggestion to save money. He writes:

The main problem with intranasal ketorolac is its cost. On GoodRx.com the price of 5 vials of Sprix (with a coupon) is about $1,000. Each vial is good for one day of use; it contains 8 sprays (15 mg each) and the usual dose is one spray into each nostril, repeated every 6 hours as needed. However, there is a way around the cost of this medication. Ten 30 mg vials of generic ketorolac for injections cost $15. You just need to buy a nasal spray bottle, empty the contents of the vial into it and use it as needed.

Check with your doctor and your insurance company to confirm which option is best for you.

To read the ketorolac vs. sumatriptan study results, visit A Randomized Trial of Ketorolac vs Sumatripan vs Placebo Nasal Spray (KSPN) for Acute Migraine