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Differential actions of indomethacin: clinical relevance in headache

Research output: Contribution to journalArticlepeer-review

Oliver Summ, Anna Antreou, Simon Akerman, Philip Holland, Jan Hoffmann, Peter Goadsby

Original languageEnglish
Pages (from-to)591-599
Number of pages9
Issue number2
Early online date6 Aug 2020
Accepted/In press27 Jul 2020
E-pub ahead of print6 Aug 2020
Published1 Feb 2021

Bibliographical note

Publisher Copyright: Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain. Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine


  • summ-COX-TCC-Pain-Final (2)

    summ_COX_TCC_Pain_Final_2_.pdf, 440 KB, application/pdf

    Uploaded date:30 Jul 2020

    Version:Accepted author manuscript

    Licence:CC BY-NC-ND

King's Authors


ABSTRACT: Nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, are used routinely in the treatment of primary headache disorders. Indomethacin is unique in its use in the diagnosis and treatment of hemicrania continua and paroxysmal hemicrania. The mechanism of this specific action is not fully understood, although an interaction with nitric oxide (NO) signaling pathways has been suggested. Trigeminovascular neurons were activated by dural electrical stimulation, systemic administration of an NO donor, or local microiontophoresis of L-glutamate. Using electrophysiological techniques, we subsequently recorded the activation of trigeminovascular neurons and their responses to intravenous indomethacin, naproxen, and ibuprofen. Administration of indomethacin (5 mg·kg-1), ibuprofen (30 mg·kg-1), or naproxen (30 mg·kg-1) inhibited dural-evoked firing within the trigeminocervical complex with different temporal profiles. Similarly, both indomethacin and naproxen inhibited L-glutamate-evoked cell firing suggesting a common action. By contrast, only indomethacin was able to inhibit NO-induced firing. The differences in profile of effect of indomethacin may be fundamental to its ability to treat paroxysmal hemicrania and hemicrania continua. The data implicate NO-related signaling as a potential therapeutic approach to these disorders.

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