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Migraines sufferers know that migraine headaches are debilitating. During a migraine, one may experience intense pain, nausea, vomiting and sensitivity to light and sound. Typically, it is recommended nonsteroidal anti-inflammatory drugs (NSAIDS) like naproxen be tried first, if appropriate, to obtain relief. If that doesn’t work, a class of medications referred to as ‘triptans’ can be tried. However, there are a significant number of migraine sufferers who do not get relief from triptans alone. For this reason, you will be hearing about a new drug for migraine relief. The drug is called Treximet®. It is a combination of sumatriptan and naproxen.
 Sumatriptan is an example of a triptan. These types of medications work by constricting the blood vessels in the brain. Naproxen is an example of an NSAID. NSAIDs work in part by decreasing inflammation. The combination was approved by the FDA in April 2008 for the treatment of migraine headaches. It is no coincidence that the company offering the medication owns the patent to brand name sumatriptan (Imitrex®) which will be going off patent early next year. A drug patent gives a company the exclusive right to manufacturer and sell a drug formulation. When medications go off patent, it gives other companies the right to start manufacturing and selling the same formula.
Despite possible ulterior motives for producing the new drug, the combination may be beneficial to some people. Treximet®contains a combination of both medications and costs 10% less than brand name Imitrex® tablets. Further, this combination may be helpful to those who do not obtain relief from a triptan alone. Using two different drugs with two different mechanisms of action can help ‘attack’ the migraine from more than one angle. The combination seems to show an increased response and decreased incidence of rebound headache.(1)
Although the result of taking a second dose of Treximet® has not really been established, the manufacturer of the drug states that a second dose may be taken if relief is not obtained from the first dose. However, one should wait at least 2 hours before taking a second dose. One should not take more than 2 tablets in 24 hours.(2) Note that triptans and NSAIDS are not meant to be used to prevent headaches. If you experience frequent migraines, you should talk to your doctor about possible prophylaxis. There are a variety of medications that can be taken regularly to prevent migraines including tricyclic antidepressants, beta-blockers, divalproex and topiramate.
Conclusion
Talk to your doctor before starting any new migraine therapy. It is recommended to try NSAIDS first before trying a triptan like sumatriptan for mild to moderate pain. If NSAIDS alone do not work, it a triptan may be helpful. Combination therapy should be reserved for those who do not obtain relief from a triptan alone. Both naproxen and sumatriptan are available separately. This can make it easier to start with one and add the other if relief is not obtained. Remember there is no evidence that shows the combination of naproxen and sumatriptan found in Treximet® is superior to taking the two drugs separately.
Author: Christi Larson, Pharm. D.
Dr. Larson is a Clinical Infusion Pharmacist, author of Empowered Medicine; A Guide for Consumers and creator of www.empoweredmedicine.com. You can read more about her by visiting www.EmpoweredMedicine.com and clicking on the 'About Us' tab. EmpoweredMedicine.com is committed to providing evidence-based medical information.
REFERENCES
1. Brandes JL, Kudrow D, Stark SR, et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA 2007;297:1443-54.
2. Product information for Treximet. GlaxoSmithKline. Research Triangle Park, NC 27709. April 2008.
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