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Migraine Drug Cambia Associated with Increased Risk of Heart Attack, Stroke

Cambia (diclofenac) is a type of pain medication called non-steroidal anti-inflammatory drugs (NSAID) that is FDA approved for treatment of migraine attacks in adults. But research indicates diclofenac is as likely to be associated with a heart attack or stroke, particularly among those with existing cardiovascular risk factors, as an NSAID called Vioxx (rofecoxib) that was removed from the market in 2004 due to safety concerns. By some estimates diclofenac is more likely to be linked to a cardiovascular event.

For migraine patients who cannot safely take triptans or need additional options, Cambia can be an important acute treatment alternative. Cambia is a packet of powder that you mix into a small amount of water and drink. This provides faster relief than could be offered by any pill form of NSAID.

Researchers note there is a perception among some doctors and patients that diclofenac is a stronger pain medication than other NSAIDs, partly, perhaps, because it is by prescription only. The reality is this is not the case. Other, safer NSAIDs, such as over the counter pain medication naproxen, may be able to replicate the results experienced by patients who have been using diclofenac. While naproxen is associated with cardiovascular events just like all NSAIDs, it has the lowest risk of any medication in the category. As is true for diclofenac, naproxen is associated with fewer stomach-related side effects than some NSAIDs. Unfortunately Cambia is the only NSAID that comes in a form more friendly to the migraine stomach and its unique needs (Migraine & Gastroparesis).

So what’s the takeaway? Talk to your doctor about your cardiovascular risk factors and decide with your doctor whether Cambia is the right migraine treatment option for you.

While it is undoubtedly scary that the cardiovascular events associated with use of diclofenac can occur with absolutely no warning, we encourage you not to be discouraged or panic. There are many things you can do to reduce your cardiovascular risk factors, and if you and your doctor determine Cambia isn’t a good fit for your situation, you can stop taking it.

In addition to Cambia, diclofenac is sold under the brand names Voltaren, Cataflam and Zipsor.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. Patricia McGettigan, David Henry, “Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries,” PLoS Med, Published online Feb. 12, 2013,doi:10.1371/journal.pmed.1001388. 2. K. Srinath Reddy, Ambuj Roy, “Cardiovascular Risk of NSAIDs: Time to Translate Knowledge into Practice,” PLoS Med, Published online Feb. 12, 2013, doi:10.1371/journal.pmed.1001389. 3. Richard Knox, “World’s Most Popular Painkiller Raises Heart Attack Risk,” NPR.org, Feb. 12, 2013, http://www.npr.org/blogs/health/2013/02/12/171832741/worlds-most-popular-painkiller-raises-heart-attack-risk, accessed Feb. 15, 2013.

Comments

  • Kate Barsotti
    5 years ago

    Cambia has been great for me. I tried cheaper alternatives, but the side effects were brutal.

    The insurance company had been paying for it…and now they dropped it without notice. Nothing rings in the new year like humiliation for migraine sufferers. Last year was the best year I’ve had in decades.

  • Dr. Alex Mauskop
    6 years ago

    I admit that I am biased since I developed Migralex, which contains aspirin, but the fact remains that aspirin is the only NSAID that not only does not increase the risk of strokes and heart attacks, but can prevent them (it also prevents many forms of cancer). Since migraine with aura is associated with an increased risk of strokes it may be prudent to avoid diclofenac if you have auras. You should also avoid it if you have other risk factors for cardiovascular disease, such as smoking, high blood pressure, high cholesterol, diabetes, family history of strokes and heart attacks, etc.

  • 6 years ago

    It should be noted that a lot NSAIDs, especially Vioxx, were used daily for arthritic pain, etc. The daily use is probably what contributes most to the cardiovascular risk. That’s why you only get 6-12 Cambia per month for migraine. NSAIDs shouldn’t be used daily for migraine prevention anyway.

  • BethBlue
    6 years ago

    I wholeheartedly agree with Dr. Whyte’s comment. Migraineurs are only supposed to be using Cambia when it is absolutely necessary (for instance; combined with Maxalt during an intractable episode). I also believe that Cambia gets a bad rap because users are so averse to the taste (I happen to be among the minority). It works for me, so I truly hope it stays on the market.

  • Cindi
    6 years ago

    This stuff is good to know, esp since everything is so “trial and error” with us. THANKS!!

  • Diana-Lee author
    6 years ago

    Indeed! I hope it will be useful information so everyone can make a decision with all the facts in mind.

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