Acute migraine attack: the place of nonsteroidal anti-inflammatory drugs in the updated guidelines

Zakrevska M.I.

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Acute migraine attack: the place of nonsteroidal anti-inflammatory drugs in the updated guidelines

August 11, 2026

Neurology and Psychiatry

Zakrevska M.I.

УДК: 616.867

DOI: 10.32471/umj.1680-3051.279531

Keywords :

acute migraine attack,

dexketoprofen trometamol,

headache,

migraine,

nonsteroidal anti-inflammatory drugs

Specialities :

Neurology and Psychiatry

Resume

Migraine is a common disabling neurological disease that primary care physicians and neurologists around the world, including Ukraine, encounter daily. Despite the presence of clear diagnostic criteria of ICHD-3, migraine still remains an underdiagnosed and suboptimally treated condition. The article summarizes current approaches to the treatment of acute migraine attacks, including the updated 2024–2025 recommendations of the International Headache Society and the American Headache Society on parenteral therapy in the emergency department, identifies the place of nonsteroidal anti-inflammatory drugs at different stages of treatment, and reviews in detail the evidence base for dexketoprofen, an original molecule with proven pharmacokinetic advantages among nonsteroidal anti-inflammatory drugs.

References

1. Ashina M., Buse D.C., Ashina H. et al. (2021) Migraine: integrated approaches to clinical management and emerging treatments. Lancet, 397: 1505–1518.
2. Robblee J., Minen M.T., Friedman B.W. et al. (2026) 2025 guideline update to acute treatment of migraine for adults in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies. Headache, 66(1): 53–76. doi: 10.1111/head.70016.
3. Headache Classification Committee of the International Headache Society (IHS) (2018) The International Classification of Headache Disorders, 3rd edition (ICHD-3).
4. UpToDate. Acute treatment of migraine in adults.
5. Silberstein S.D., Rosenberg J. (2000) Multispecialty consensus on diagnosis and treatment of headache. Neurology, 54: 1553.
6. Silberstein S.D. (2000) Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 55: 754.
7. International Headache Society (2024) IHS publishes Global practice recommendations for the acute pharmacological treatment of migraine.
8. Puledda F., Sacco S., Diener H.C. et al. (2024) International Headache Society global practice recommendations for the acute pharmacological treatment of migraine. Cephalalgia, 44(8). doi: 10.1177/03331024241252666.
9. Gungor F., Akyol K.C., Kesapli M. et al. (2016) Intravenous dexketoprofen vs placebo for migraine attack in the emergency department: A randomized, placebo-controlled trial. Cephalalgia, 36(2): 179–184. doi: 10.1177/0333102415584604.
10. Karacabey S., Sanri E., Yalcinli S. et al. (2018) Which is more effective for the treatment of Acute Migraine Attack: Dexketoprofen, Ibuprofen or Metoclopramide? Pak. J. Med. Sci., 34(2): 418–423. doi: 10.12669/pjms.342.13815.
11. Allais G., Rolando S., Schiapparelli P. et al. (2013) Frovatriptan plus dexketoprofen in the treatment of menstrually related migraine: an open study. Neurol. Sci., 34(Suppl. 1): S179–S181. doi: 10.1007/s10072-013-1390-0.
12. Allais G., Bussone G., Tullo V. et al. (2015) Frovatriptan 2.5 mg plus dexketoprofen (25 mg or 37.5 mg) in menstrually related migraine. Subanalysis from a double-blind, randomized trial. Cephalalgia, 35(1): 45–50. doi: 10.1177/0333102414542290.
13. Mauleón D., Artigas R., García M.L. et al. (1996) Preclinical and clinical development of dexketoprofen. Drugs, 52 (Suppl. 5): 24–45. doi: 10.2165/00003495-199600525-00005.
14. Rodríguez M.J., Arbós R.M., Amaro S.R. (2008) Dexketoprofen trometamol: clinical evidence supporting its role as a painkiller. Expert Rev. Neurother., 8(11): 1625–1640. doi: 10.1586/14737175.8.11.1625.
15. Barbanoj M.J., Antonijoan R.M., Gich I. (2001) Clinical pharmacokinetics of dexketoprofen. Clin. Pharmacokinet., 40(4): 245–262. doi: 10.2165/00003088-200140040-00002.
16. Hanna M., Moon J.Y. (2019) A review of dexketoprofen trometamol in acute pain. Curr. Med. Res. Opin, 35(2): 189–202. doi: 10.1080/03007995.2018.1457016.
17. Kuczyńska J., Pawlak A., Nieradko-Iwanicka B. (2022) The comparison of dexketoprofen and other painkilling medications (review from 2018 to 2021). Biomed Pharmacother., 149: 112819. doi: 10.1016/j.biopha.2022.112819.
18. Mainardi F., Maggioni F., Pezzola D. et al. (2014) Dexketoprofen trometamol in the acute treatment of migraine attack: a phase II, randomized, double-blind, crossover, placebo-controlled, dose optimization study. J. Pain, 15(4): 388–394. doi: 10.1016/j.jpain.2013.12.006.
19. Yavuz E., Gulacti U., Lok U. et al. (2020) Intravenous metoclopramide versus dexketoprofen trometamol versus metoclopramide + dexketoprofen trometamol in acute migraine attack in the emergency department: a randomized double-blind controlled trial. Am. J. Emerg. Med., 38(11): 2254–2258. doi: 10.1016/j.ajem.2020.04.038.
20. Şafak S., Çorbacıoğlu Ş.K., Korucu O. et al. (2022) Comparison of ibuprofen and dexketoprofen in the management of migraine-related headache in the emergency department. Notfall Rettungsmed, 25(Suppl. 2): 31–37. doi: 10.1007/s10049-022-01105-w.