Expert Answer: NSAIDs for migraine

Question: A few years ago I suffered a sports/medicine related knee injury and was on Voltaren for 2 years. During that time of taking Voltaren I only had 2 migraines! My doctor has offered to let me take the Voltaren again as I'm now having arthritis issues and it helps with the migraines. How does the Voltaren affect my body to prevent the migraines?

Voltaren is a non-steroidal anti-inflammatory medication. This class of medication is often referred to as the NSAIDs. This class includes commonly known medications such as Ibuprofen and Naproxen. Migraine is an inflammatory event; one of the pathways involved in migraine involved the production and release of prostaglandins. Voltaren and other NSAIDs help to block the production and release of prostaglandins. Therefore, it makes sense that Voltaren worked well to prevent your body's migraines.

Interestingly, there is an oral powder from of Voltaren (generic name Diclofenac) that comes as a 50 mg strength packet; it is mixed with water and swallowed orally. It is FDA approved for migraine attacks. Prior to being taken off the market, another anti-inflammatory called Vioxx was FDA approved for acute migraine attacks and was very helpful for many patients, particularly those who had contraindications to taking tritpans.

As you can see, NSAIDs like Voltaren can be used to treat an acute migraine attack and can also be used on a daily basis for migraine prevention. The mechanism of action would be the anti-inflammatory effect due to the inhibition of the production and release of prostaglandins.

Taking Voltaren everyday to prevent migraines would carry the same risk as the daily use of an NSAID for other conditions such as arthritis. Risks include gastrointestinal ulcers; gastrointestinal bleeding; and kidney and liver issues. I recommend regular monitoring of blood tests be done for any migraine patient taking an NSAID on a daily basis for prevention.

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