Indomethacin

In the 1970's specialists realised that some cluster-like headaches responded really well to this drug.

Of all the headache medications available, this is the best one to try for people with constant severe pain on one side of the head. unilateral headaches.

It should also be used in headaches that sound like cluster headache, where there is watering of the eye, nasal stuffiness or reddening of the eye (the "autonomic cephalalgias").

It is used a lot by headache specialists as there are several conditions for which it seems very helpful.

These include:

1. Paroxysmal Hemicrania (if you don't respond you probably do not have this diagnosis!)
2. Ice-pick Headache
3. Primary Exercise Headache
4. Cough Headache
5. Primary Headache Associated with Sexual Activity
6. Hemicrania Continua
7. Migraine - can be used as a suppository to treat a severe migraine attack, or can be taken before sport to prevent a sport-related migraine headache)
8. Hypnic Headache
9. Nummular Headache

It can also upset control of asthma. Cardiac or renal failure can occur, especially in older persons. Again these are quoted as <1% risks.

Remember this is a prescription only drug, and should only ever be used following a recommendation from your doctor.

To find out if a headache will respond to indomethacin, I usually start at 25mg three times daily with Omeprazole 20mg once daily. After 2 weeks I increase to 50mg three times daily for a further 2 weeks.

Lastly if there is still pain, I increase to 75mg three times a day. If there is no response to 75mg three times daily, the headache is judged non-responsive.

There is an injectable form of of the drug, which can provide a more rapid assessment of whether a headache is sensitive to this unusually potent headache treatment.

References