I have looked into several different types of migraine treatments, including piroxicam, ibuprofen, indomethacin, ketorolac, and ketoprofen, and I was wondering if you could tell me which NSAID is most effective.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to stop a migraine shortly after its onset. Many of these medications have been proven clinically effective for the acute treatment of migraine headache. There are a variety of NSAIDs that are over-the-counter as well as by prescription. Naproxen and ibuprofen are the most common over-the-counter ones that are used. Prescription ibuprofen is exactly the same as over-the-counter ibuprofen except stronger. Frequently used prescription NSAIDs include diclofenac, etodolac, indomethacin, ketoprofen, nabumetone, and piroxicam. Ketorolac is also a prescription NSAID that can be used in pill form or in injection form; however this medication should not be used for more than five days in a row because of the likelihood of causing stomach irritation and ulceration.

I suggest that my patients try one NSAID for several migraine headaches and if there is no significant response, then a different NSAID should be tried. There is no way to predict which NSAID will be effective for each individual, and the lack of response to one agent does not preclude response to another. The limiting factor with many of these medications is gastrointestinal irritation and possibly gastrointestinal bleeding. I do not use these medications in people who are taking blood thinning medications such as Coumadin, Plavix, Aggrenox or aspirin due to the likelihood of bleeding with this combination. I also avoid these medications in people with a history of gastrointestinal problems. If you have tried over-the-counter NSAIDs without success, then it would be reasonable to discuss with your physician whether prescription NSAIDs or other prescription medications should be tried for your headaches.

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