Migraine headaches
 

Treatment (Prescriber's Letter: May 2004; Vol: 11, No. 5)

Reps will be promoting Vioxx (rofecoxib) for migraines. It's the first COX-2 inhibitor approved for this use.
     This is not a surprise.
     NSAIDs are commonly used to treat migraines.
     In fact, there's some evidence that ibuprofen might be MORE effective than Vioxx for migraines.
     For initial therapy, use an NSAID (aspirin, ibuprofen, naproxen, etc) or Excedrin.
     Use a triptan (Imitrex, etc) or DHE (Migranal) if an NSAID isn't enough.
     Consider using both an NSAID and triptan for patients who need more than either drug alone. The combo might boost efficacy and help prevent recurrent headaches.
     Save opioids (Stadol NS, Fiorinal with Codeine, etc) as a last resort.
     Remind patients that frequent use of analgesics often leads to rebound headaches.
     For patients who use acute meds more than twice a week, consider prophylactic treatment...divalproex (Depakote), beta-blockers, tricyclic antidepressants, etc.