Sumatriptan and naproxen sodium for the acute treatment of migraine
 

: Headache. 2005 Sep;45(8):983-91. Related Articles, Links

Sumatriptan and naproxen sodium for the acute treatment of migraine.

Smith TR, Sunshine A, Stark SR, Littlefield DE, Spruill SE, Alexander WJ.

Objective.-To evaluate the efficacy and tolerability of treatment with a combination of sumatriptan 50 mg (encapsulated) and naproxen sodium 500 mg administered concurrently in the acute treatment of migraine. Background.-The pathogenesis of migraine involves multiple peripheral and central neural mechanisms that individually have been successful targets for acute (abortive) and preventive treatment. This suggests that multimechanism therapy, which acts on multiple target sites, may confer improved efficacy and symptom relief for patients with migraine. Design and Methods.-This was a multicenter, randomized, double-blind, double-dummy, placebo-controlled, four-arm study. Participants (n = 972) treated a single moderate or severe migraine attack with placebo, naproxen sodium 500 mg, sumatriptan 50 mg, or a combination of sumatriptan 50 mg and naproxen sodium 500 mg. In the latter two treatment arms, the sumatriptan tablets were encapsulated in order to achieve blinding of the study. Results.-In the sumatriptan plus naproxen sodium group, 46% of subjects achieved 24-hour pain relief response (primary endpoint), which was significantly more effective than sumatriptan alone (29%), naproxen sodium alone (25%), or placebo (17%) (P < .001). Two-hour headache response also significantly favored the sumatriptan 50 mg plus naproxen sodium 500 mg therapy (65%) versus sumatriptan (49%), naproxen sodium (46%), or placebo (27%) (P < .001). A similar pattern of between-group differences was observed for 2-hour pain-free response and sustained pain-free response (P < .001). The incidence of headache recurrence up to 24 hours after treatment was lowest in the sumatriptan plus naproxen sodium group (29%) versus sumatriptan alone (41%; P = .048), versus naproxen sodium alone (47%; P= .0035), and versus placebo (38%; P= .08). The incidences of the associated symptoms of migraine were significantly lower at 2 hours following sumatriptan 50 mg plus naproxen sodium 500 mg treatment versus placebo (P < .001). The frequencies and types of adverse events reported did not differ between treatment groups, with dizziness and somnolence being the most common. Conclusions.-This is among the first prospective studies to demonstrate that multimechanism acute therapy for migraine, combining a triptan and an analgesic, is well tolerated and offers improved clinical benefits over monotherapy with these selected standard antimigraine treatments. Specifically, sumatriptan 50 mg (encapsulated) and naproxen sodium 500 mg resulted in significantly superior pain relief as compared to monotherapy with either sumatriptan 50 mg (encapsulated) or naproxen sodium 500 mg for the acute treatment of migraine. Because encapsulation of the sumatriptan for blinding purposes may have altered its pharmacokinetic profile and thereby decreased the efficacy responses, additional studies are warranted that do not involve encapsulation of the active treatments and assess the true onset of action of multimechanism therapy in migraine. This study did show that the combination of sumatriptan and naproxen sodium was well tolerated and that there was no significant increase in the incidence of adverse events compared to monotherapy. (Headache 2005;45:983-991).

Удивляет общая довольно низкая эффективность препаратов: на монотерапии 2 часовой безболевой промежуток менее 50%...
А вообще, странно, что такая простая идея не приходила никому раньше...

Для монотерапии напроксеном в принципе понятно, а такой ответ на суматриптан, как они сами указывают, возможно связан с тем, что в целях конспирации таблетку заключали в капсулу (так я понял) и что возможно оказало влияние на фармакокинетику препарата. Ну во всяком случае комбинированная терапия показала хорошие результаты. А вот еще свежая статейка про головные боли напряжения.

Rev Neurol (Paris). 2005 Jul;161(6-7):720-2. Related Articles, Links

[Tension-type headache.]

[Article in French]

Fumal A, Schoenen J.

Departements Universitaires de Neurologie et Neuroanatomie, CHR Citadelle, Liege, Belgique.

The diagnosis of tension-type headache (TTH), a heterogeneous syndrome, is mainly based on the absence of typical features found in other headaches such as migraine. However TTH is the most common headache as about 80 percent of the general population suffer from episodic TTH and 3 percent have chronic TTH (CTTH). The underlying pathophysiology is complex. The present consensus is that peripheral pain mechanisms most likely play a role in infrequent and frequent episodic TTH whereas central pain mechanisms play a more important role in CTTH. Ibuprofen (800mg) is currently the leading choice for the treatment of acute TTH because of its very good gastro-intestinal tolerance, followed by sodium naproxen (825mg). Tricyclic antidepressants are the most widely used first-line therapeutic agents for CTTH (amitriptyline is the most widely used). Other preventive treatments such as relaxation, muscular biofeedback and behavioural (cognitive) techniques have also showed efficacy. It is demonstrated that the combination of stress management therapy and a tricyclic is more effective in CTTH than either behavioral or drug treatment alone.

PMID: 16141970 [PubMed - in process]