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Posted by Paco ( on November 30, 2001 at 08:55:51:

In Reply to: Need some advice guys posted by Trudy on November 30, 2001 at 08:18:37:

Chronic paroxysmal hemicrania Almost all patients with chronic or episodic paroxysmal hemicrania have their headaches eliminated by indomethacin, which for CPH generally has to be taken for years. Sometimes large doses (200 mg per day) are needed to suppress the attacks. Indomethacin, like other non-steroidal anti-inflammatory drugs (NSAIDS) can produce intolerable dyspepsia, which may or may not be alleviated by antacids, such as cimetidine, and it can cause perforated or bleeding stomach or duodenal ulcers. When indomethacin is not tolerated (or effective) other drugs should be tried. One case report (Warner et al., 1994) stated that a patient with CPH unresponsive to indomethacin had her headaches suppressed by acetazolamide (Diamox) in a dosage of 250 mg three times daily. More recently, Mathew et al. (2000) reported a woman with CPH who had to discontinue indomethacin for intolerable gastric symptoms due to multiple ulcers. She was then treated with celecoxib (Celebrex), a drug in a new class of NSAIDs which decrease prostaglandin synthesis by inhibiting the enzyme cyclo-oxygenase-2 (COX-2) without affecting cyclo-oxygenase-1, as does indomethacin and the older NSAIDs such as aspirin, ibuprofen, etc. On a dose of 200 mg twice daily, her headache attacks remitted within 3 days and remained absent for the 3-month follow up--and without gastric symptoms.

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