100 Migraine Drugs, A to Z: diclofenac

Diclofenac (Cambia, Voltaren) is one of the nonsteroidal anti-inflammatory drugs (NSAIDs) used for the treatment of migraine headaches. Cambia, which contains 50 mg of powdered diclofenac, is specifically approved by the FDA for the treatment of migraine headaches. It works faster because the powder gets dissolved in a glass of water and the solution of diclofenac (or any other drug) gets absorbed faster than a solid pill. Cambia has a licorice taste, so if you are born disliking licorice (yes, it is an inherited trait), this drug is not for you. It is also not for you if your insurance refuses to pay for it – the out-of-pocket cost is $70 to $80 for a single a dose, or $630 to $740 for a box of 9 packets.

The insurers rightfully want you to first try generic diclofenac in a tablet form, which costs $0.30 a pill. Drinking a full glass of water will speed up the dissolution of the tablet and in some patients could potentially match the efficacy of Cambia.

Taking diclofenac in any formulation on an empty stomach makes it work faster, but may increase the risk of heartburn and peptic ulcers. All NSAIDs taken very frequently can increase the risk of heart attacks and strokes in people with cardiovascular risk factors. However, some NSAIDs are worse than other and diclofenac is one of the worst ones while naproxen is one of the safest ones.

I mention this on every suitable occasion – NSAIDs have not been proven to cause rebound or medication overuse headaches (MOH). In fact, daily intake of naproxen was proven to be an effective strategy for the prevention of migraines. MOH has been only proven to occur from a frequent intake caffeine and opioid (narcotic) pain killers.