Indomethacin has no effect on trigeminally provoked parasympathetic output

• Published in: Cephalalgia Vol. 42; no. 1; pp. 37 - 43
• Main Authors: Möller, Maike, Schröder, Celina, Iwersen-Bergmann, Stefanie, Mehnert, Jan, May, Arne
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2022
• Subjects: Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Headache; Humans; Ibuprofen - pharmacology; Ibuprofen - therapeutic use; Indomethacin - pharmacology; Indomethacin - therapeutic use; Original; Paroxysmal Hemicrania; Trigeminal Autonomic Cephalalgias; hemicrania continua; lacrimation; headache; paroxysmal hemicrania; NSAID
• ISSN: 0333-1024; 1468-2982; 1468-2982
• DOI: 10.1177/03331024211030901

Background Unlike other non-steroidal anti-inflammatory drugs, indomethacin has been shown to be highly effective in two forms of trigeminal autonomic cephalalgias, hemicrania continua and paroxysmal hemicrania and in some forms of idiopathic stabbing headaches. This specificity is unique in the headache field. Previous findings suggest the involvement of the trigeminal autonomic reflex to play an important role in the pathophysiology of these diseases. Methods 22 healthy participants were enrolled in a double-blind, three-day within-subject design. The participants received indomethacin, ibuprofen or placebo in a randomized order. After an incubation period of 65 min the baseline lacrimation and the lacrimation during intranasal stimulation evoked by kinetic oscillation stimulation were assessed using Schirmer II lacrimation tests. The lacrimation difference in mm was calculated and compared in a repeated measures ANOVA. Results No significant differences were found between the three conditions. Conclusion In our study, neither indomethacin nor ibuprofen had an inhibitory effect on the trigeminal autonomic reflex. We suggest that blocking this reflex may not be the treatment mechanism of indomethacin.