Celebrex As a Migraine Treatment

Commonly used for arthritis, it can reduce migraine-related inflammation

Celebrex
Pillbox

Celebrex (celecoxib)—a prescription nonsteroidal anti-inflammatory drug (NSAID) approved for the treatment of osteoarthritis, rheumatoid arthritis, acute pain in adults, and other conditions—is not considered a first-line migraine medication. However, it can be used for some types of headaches and migraines, especially when inflammation is believed to play a major role in causing the pain.

Your doctor may consider prescribing Celebrex for treatment of your acute headaches or migraines, particularly if you experience stomach upset from taking other NSAIDs.

How It Works

Celebrex targets an enzyme called COX-2, which is responsible for inflammation in the body. Other NSAIDs, such as ibuprofen and naproxen, are called non-selective NSAIDs because they target both COX-2 and COX-1 enzymes to reduce prostaglandin-induced inflammation. COX-1 helps maintain the lining of the stomach and intestines.

While NSAIDs can reduce pain and inflammation by targeting COX-1, they can also cause injury to the stomach and intestinal lining, leading to gastrointestinal bleeding and ulcers.

By selectively targeting COX-2, Celebrex does not increase the risk of stomach and intestinal problems the way non-selective NSAIDs do. 

Efficacy

Celebrex may be effective in treating migraines associated with inflammation. According to one study, medication withdrawal headaches, which are usually treated with prednisone, a steroid that has a powerful anti-inflammatory effect, can improve in response to Celebrex.

And a case report described the improvement of herpes simplex virus (HSV)-associated migraines (which likely have an inflammatory component) using a combination of celecoxib and antiviral treatment.

Celebrex is not among the most effective therapeutic approaches for acute headaches or migraines. However, the drug generally works as well as over-the-counter NSAIDs in people whose head pain is improved after taking these drugs.

Celebrex is less likely to cause stomach upset and gastrointestinal bleeding than most other NSAIDs, which can make it a preferred option if you are at risk of these problems.

Formulation

Celebrex comes in capsule form, in doses of 50 mg, 100 mg, 200 mg, and 400 mg.

There is also a liquid formulation of celecoxib called DFN-15. While it has been used in migraine research, this form of the medication is has not been approved by the United States Food and Drug Administration (FDA).

Dosing

The manufacturer recommends taking the lowest effective dose of this medication.

For treatment of pain, it can be started with a one-time dose of 400 mg, followed by another 200 mg tablet on the same day. The usual dose for management of acute pain in adults is 200 mg twice per day.

In Children

Celebrex is approved for use in children 2 years and older.

Those who weigh between 22 to 55 pounds can take 50 mg of Celebrex twice per day. Children who weigh more than 55 pounds can take 100 of Celebrex mg twice per day.

Of course, the dose appropriate for you or your child will be confirmed by your doctor.

Side Effects

The most common side effects of Celebrex include flatulence, diarrhea, dizziness, swelling, and upper respiratory infection.

Other side effects include:

  • An allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives)
  • Unexplained weight gain
  • Swelling or water retention
  • Unusual fatigue or lethargy
  • A skin rash or itching
  • Yellowing of your skin or eyes
  • "Flu-like" symptoms
  • Unusual bruising or bleeding

Contraindications

Celebrex is generally considered safe, but you should not use it if you have the following risk factors:

  • You have had asthma, hives, or an allergic reaction to an NSAID in the past
  • You have had a reaction to sulfonamides in the past
  • You have had or are planning to have heart bypass surgery
  • You are pregnant and past 30 weeks' gestation

Interactions

Celebrex interacts with a number of other medications, and you should tell your doctor and pharmacist about all other prescription, over-the-counter, and vitamins that you are taking before you start your new prescription.

Celebrex interacts with:

  • Anti-inflammatory medications, such as NSAIDs and steroids, such as cortisone and prednisone. The combination can cause gastrointestinal upset, ulceration, and bleeding, and may increase the risk of vascular events.
  • Blood thinners: Celebrex can increase the risk of bleeding when taken with these drugs.
  • Blood pressure lowering medications: Celebrex can cause heart problems when taken with medications that reduce blood pressure, including diuretics.
  • Digoxin, lithium, methotrexate, cyclosporin: Celebrex can interfere with the metabolism of these powerful medications, and increases their blood levels, leading to toxic levels.

COX-2 Warnings

Vioxx (rofecoxib), another COX-2 inhibitor, was withdrawn from the U.S. market in 2004 due to cardiovascular problems.

While there has been concern regarding similar risks with Celebrex, celecoxib has not been associated with a risk of cardiovascular problems. Studies have shown that the risk of cardiovascular problems with celecoxib is low, and approximately equal to that of non-selective NSAIDS, ibuprofen, and naproxen.

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