100 Migraine Drugs, A to Z: meloxicam

Meloxicam (Mobic) is a non-steroidal anti-inflammatory drug (NSAID) which is approved for the treatment of rheumatoid arthritis and osteoarthritis in adults and juvenile rheumatoid arthritis in children older than 2 years. Meloxicam tends to be better tolerated than some other NSAIDs. The main side effects of NSAIDs are heartburn (reflux), stomach pain, and peptic ulcers.

Although there have been no trials of meloxicam for the acute or prophylactic treatment of migraine headaches, it is probably as effective as other NSAID that have been tested for migraines. One advantage of meloxicam is that the effect of a single dose lasts all day. This makes it particularly suitable for the prevention of migraine attacks. It is also available in a liquid form, which can work faster than a solid tablet and speed of onset can be important when using it for acute therapy since faster acting drugs tend to be more effective. Meloxicam tablets are available in 7.5 and 15 mg strength.

An abstract presented at the recent meeting of the International Headache Society describes a new combination product in development for the acute treatment of migraines, which includes meloxicam, 20 mg with rizatriptan (Maxalt), 10 mg. This is a product similar to the combination of naproxen with sumatriptan (Treximet) and just like Treximet is likely to be more effective than either drug alone. However, being a branded drug it is likely to be much more expensive than generic drugs and not likely to be covered by most insurance plans. The insurers usually require that a patient first tries taking sumatriptan and naproxen as separate tablets and if that does not work, will occasionally pay for Treximet. I do have a small number of patients who respond much better to Treximet than to sumatriptan and naproxen taken as separate pills. This can be due to several factors. Most commonly, certain generics may not dissolve as fast as the branded product. Another possible explanation is that the acidity of NSAIDs such as naproxen or meloxicam facilitates absorption of triptans, which could be more pronounced if they are in close contact.