What is the recommended treatment for acute migraine attacks using Cambia (diclofenac potassium)?

Cambia (Diclofenac Potassium) for Acute Migraine Treatment

For acute migraine attacks, Cambia (diclofenac potassium powder for oral solution) is recommended at a dose of 50 mg taken at the onset of migraine pain, providing rapid relief beginning as early as 15 minutes after administration. 1

Mechanism and Formulation

Cambia is a non-steroidal anti-inflammatory drug (NSAID) that works by inhibiting prostaglandin synthesis, which plays a key role in migraine pathophysiology. The powder for oral solution formulation offers several advantages over traditional tablet forms:

• Faster absorption with maximal plasma concentrations achieved within 15 minutes 1
• More rapid onset of analgesic effect compared to diclofenac tablets 2
• Effective pain relief maintained over a 24-hour period 1

Efficacy in Acute Migraine Treatment

Cambia has demonstrated significant efficacy in treating acute migraine attacks:

• Approximately 25% of patients achieve pain freedom at 2 hours post-dose 1
• Provides significant pain relief starting at 15 minutes post-dose (compared to 60 minutes for tablet formulation) 2
• The American College of Physicians recommends NSAIDs like diclofenac as effective acute treatments for migraine 3
• Comparable efficacy to oral sumatriptan 100mg but with faster onset of action 4
• Particularly effective in reducing accompanying symptoms such as nausea 4, 5

Dosing Guidelines

• Standard dose: 50 mg taken at the onset of migraine attack 1
• Use the lowest effective dose for the shortest duration to minimize side effects 6
• Do not exceed 2 doses per day 7
• Do not use more than 3 days per week to avoid medication overuse headache 7

Safety Profile and Tolerability

Cambia is generally well-tolerated with a safety profile similar to placebo in clinical trials:

• Most common adverse events include dizziness and gastrointestinal complaints 1
• No serious adverse events have been reported in clinical trials for migraine treatment 1
• Better tolerated than sumatriptan in comparative studies 4, 5

Important Considerations and Precautions

• Gastrointestinal risk: As with all NSAIDs, there is risk of GI bleeding, ulceration, and perforation 6
• Cardiovascular risk: NSAIDs may increase risk of cardiovascular events, especially with prolonged use
• Renal effects: Monitor kidney function in patients with pre-existing renal disease
• Drug interactions: Use caution when combining with anticoagulants, corticosteroids, or other NSAIDs

Place in Migraine Treatment Algorithm

1. First-line option: Cambia can be used as a first-line treatment for acute migraine attacks 5
2. Alternative to triptans: Particularly valuable for patients who:
   • Do not respond to triptans
   • Cannot tolerate triptans
   • Have contraindications to triptans (cardiovascular disease, uncontrolled hypertension) 3
3. Beneficial for central sensitization: Patients experiencing allodynia may particularly benefit from the cyclooxygenase-blocking activity 1

Clinical Pearls

• The powder formulation must be dissolved in water before administration
• Taking at the earliest onset of migraine symptoms may improve efficacy
• Patients should be counseled about the importance of limiting use to avoid medication overuse headache
• Consider as an alternative to oral triptans when faster onset of action is desired
• Particularly useful when migraine is accompanied by significant nausea

Cambia represents an effective, rapid-acting treatment option for acute migraine attacks with advantages in speed of onset and tolerability compared to some other acute migraine treatments.