Peatfield R C, Petty R G, Rose F C
Cephalalgia. 1983 Jun;3(2):129-34. doi: 10.1046/j.1468-2982.1983.0302129.x.
We have assessed the role of mefenamic acid, a non-steroidal anti-inflammatory drug known to inhibit both the synthesis and actions of prostaglandins, as an analgesic in migraine by comparing it with the established analgesic paracetamol (acetaminophen) in a double-blind cross-over trial. Forty ambulant migraine patients were supplied with oral medication for six consecutive attacks; metoclopramide 10 mg was administered in all attacks, and paracetamol 500 mg and mefenamic acid 500 mg for three attacks each. The patients recorded the intensity of the headache at the time the medication was taken, and again after 3 hours, on a linear analogue scale. Twenty-two patients completed the trial satisfactorily. Seven had insufficient attacks and the remainder were lost to follow-up. The mean reduction in headache intensity was 36 +/- 11% on mefenamic acid and 27 +/- 10% (both mean +/- SEM) on paracetamol. While this difference is not quite statistically significant (0.1 greater than P greater than 0.05) there still remains a 28% probability that mefenamic acid is twice as potent as an analgesic. The responses in each individual patient to the two drugs were very closely correlated (P much less than 0.001). Our failure to demonstrate a convincing difference between the two analgesics leads us to speculate that peripheral prostaglandin mediated pain pathways, in which paracetamol is inactive, may be less important than central pathways, which are inhibited by both drugs.
我们通过在一项双盲交叉试验中将甲芬那酸（一种已知可抑制前列腺素合成及作用的非甾体抗炎药）与已确立的镇痛药对乙酰氨基酚（扑热息痛）进行比较，评估了甲芬那酸作为偏头痛镇痛药的作用。40名能走动的偏头痛患者连续6次发作时接受口服药物治疗；所有发作时均给予10毫克胃复安，其中3次发作给予500毫克对乙酰氨基酚，另外3次发作给予500毫克甲芬那酸。患者在服药时以及3小时后，使用线性模拟量表记录头痛强度。22名患者圆满完成试验。7名患者发作次数不足，其余患者失访。服用甲芬那酸后头痛强度平均降低36±11%，服用对乙酰氨基酚后平均降低27±10%（均为平均值±标准误）。虽然这种差异在统计学上不太显著（0.1＞P＞0.05），但甲芬那酸镇痛效力为对乙酰氨基酚两倍的可能性仍有28%。每位患者对两种药物的反应高度相关（P远小于0.001）。我们未能证明两种镇痛药之间存在令人信服的差异，这使我们推测，对乙酰氨基酚不起作用的外周前列腺素介导的疼痛途径，可能不如两种药物均能抑制的中枢途径重要。
