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Indomethacin-responsive headaches-A narrative review.

Maria Dolores Villar-Martínez1,2, David Moreno-Ajona1,2, Calvin Chan1

  • 1Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

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Summary

Indomethacin effectively treats specific headache disorders, though its exact mechanism remains unclear. Research suggests its action involves cerebral blood flow and nitrergic pathways, aiding understanding of these conditions.

Keywords:
hemicrania continuaindomethacinparoxysmal hemicrania

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is known for its efficacy in specific headache disorders.
  • The precise mechanism of action for indomethacin in these conditions is not fully understood.
  • Indomethacin-responsive headaches, including hemicrania continua and paroxysmal hemicrania, exhibit a distinct therapeutic response.

Purpose of the Study:

  • To review the pharmacokinetic and pharmacodynamic properties of indomethacin.
  • To explore proposed mechanisms of action for indomethacin in responsive headache disorders.
  • To summarize current evidence for indomethacin's use in primary and secondary headaches.

Main Methods:

  • A narrative literature review was conducted.
  • Searches were performed using PubMed and the Cochrane databases.

Main Results:

  • The review covers indomethacin's pharmacokinetic and pharmacodynamic profiles relevant to clinical practice.
  • Proposed mechanisms include effects on cerebral blood flow, intracranial pressure, and nitrergic pathways.
  • Evidence for indomethacin in primary headaches (e.g., trigeminal autonomic cephalalgias, migraine) and secondary headaches (e.g., post-traumatic) is presented.

Conclusions:

  • Understanding indomethacin's mechanisms can illuminate the pathophysiology of indomethacin-sensitive headaches.
  • Further research into these mechanisms may reveal shared pathways among these distinct headache disorders.