Joshi Shivang, Rapoport Alan M
Community Neuroscience Services, Associate Professor of Pharmacy Practice, MCPHS University, 33 Lyman Street, Suite 400, Westborough, MA 01581, USA.
Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Ther Adv Neurol Disord. 2017 Apr;10(4):217-226. doi: 10.1177/1756285616684494. Epub 2017 Feb 8.
Migraine headache affects about 12% of Western populations and is the third most common disease worldwide (sixth in terms of disability). In 1993, triptans were introduced in the United States as a new treatment for managing migraine attacks, but their use is limited by lack of response and safety concerns in some patients. Treatment options for patients with migraine who fail or cannot tolerate triptans include switching to another medication or adding an adjunctive medication. Desirable characteristics reported by patients for acute treatment of migraine attacks include complete pain relief, fast onset of action, and no pain recurrence. Diclofenac is a nonsteroidal anti-inflammatory medication that has been established as effective for acute treatment of migraine by the American Headache Society based on available evidence. Diclofenac potassium for oral solution is rapidly absorbed, achieving maximal plasma concentrations in 15 min, which coincides with a rapid onset of effect. In a comparison of diclofenac potassium for oral solution with diclofenac potassium tablets, the solution achieved a significant reduction in headache intensity beginning at 15 min compared with 60 min for the tablet. Across randomized clinical trials, approximately 25% of patients were pain free 2 h after administration of diclofenac oral solution and the effects were maintained over a 24-h period. Diclofenac potassium for oral solution is well tolerated; the most common adverse events are dizziness and gastrointestinal complaints, with incidences similar to placebo. No serious adverse events have been reported in clinical trials of diclofenac potassium for oral solution in the acute treatment of migraine. Diclofenac oral solution may offer rapid and sustained pain relief for patients who do not achieve pain resolution with other medications. In addition, patients who experience central sensitization with allodynia may benefit from the cyclooxygenase-blocking activity of diclofenac, which is needed in this advanced phase of migraine.
偏头痛影响着约12%的西方人群,是全球第三大常见疾病(按致残程度排名第六)。1993年,曲坦类药物在美国被引入作为治疗偏头痛发作的新疗法,但在一些患者中,其使用受到疗效欠佳和安全性问题的限制。对于使用曲坦类药物无效或无法耐受的偏头痛患者,治疗选择包括换用另一种药物或加用辅助药物。患者报告的理想急性偏头痛发作治疗特性包括疼痛完全缓解、起效快和无疼痛复发。双氯芬酸是一种非甾体抗炎药,根据现有证据,美国头痛协会已认定其对偏头痛急性治疗有效。口服溶液用双氯芬酸钾吸收迅速,15分钟内达到血浆最大浓度,这与起效迅速相吻合。在口服溶液用双氯芬酸钾与双氯芬酸钾片的比较中,与片剂60分钟起效相比,溶液在15分钟时头痛强度就显著降低。在多项随机临床试验中,约25%的患者在服用双氯芬酸口服溶液2小时后疼痛消失,且疗效持续24小时。口服溶液用双氯芬酸钾耐受性良好;最常见的不良事件是头晕和胃肠道不适,发生率与安慰剂相似。在口服溶液用双氯芬酸钾治疗偏头痛急性发作的临床试验中,未报告严重不良事件。对于使用其他药物无法缓解疼痛的患者,双氯芬酸口服溶液可能提供快速且持续的疼痛缓解。此外,经历中枢敏化伴痛觉过敏的患者可能受益于双氯芬酸的环氧化酶阻断活性,这在偏头痛的这一晚期阶段是必需的。