COX inhibitors for the treatment of migraine

Stephen D Silberstein MD*a & Jessica C Stirpe MDba Thomas Jefferson University, Jefferson Medical College, Jefferson Headache Center, 900 Walnut Street, Suite 200, Philadelphia, PA 19107, USA +215 955 2243; +1 215 955 2060; b Jefferson Headache Center , 900 Walnut Street, Suite 200, Philadelphia, PA 19107, USA† Author for correspondenceIntroduction: Migraine is a common headache disorder that causes significant disability. COX inhibitors (also referred to as NSAIDs) are a frequently used treatment option.Areas covered: A PubMed search provided articles relating to migraine and COX inhibitors. This article reviews the mechanism of action of NSAIDs in migraine, specifically the inhibition of COX isoenzymes and prostaglandin synthesis. Their central and peripheral effects are reviewed. The evidence for the use of NSAIDs in acute, preventive and rescue therapy, as well as other special circumstances, is discussed.Expert opinion: We use NSAIDs as first-line acute treatment for migraine in both out-patient and in-patient settings, as well as for preventive treatment in menstrual migraine. We also employ NSAIDS as a bridge therapy. We feel more research is needed to develop a greater variation of dosage forms for current NSAIDs as well as more combination therapies.