Dr. Dave Miller, R. Ph., Ph. D., FIACP, FACA - October 31, 2022

Migraines are awful. They are debilitating and cause tremendous difficulties in people's lives and the lives of those around them. As most people who suffer from migraines know, available treatments are not terribly effective. However, a newly rediscovered article demonstrates a therapy that may provide hope to people suffering from migraines.

In a 1993 article in the journal Headache published by the American Headache Society, researchers found a novel treatment to help people with headache pain by using an old drug with a new method to get the drug into the body[1]. In this study, researchers studied the effect of piroxicam delivered under the tongue in a dosage form called a troche.

A troche is a small, square-shaped tablet that slowly dissolves either under the tongue or between the cheek and gum. Troches are different than tablets or capsules that are swallowed because, in theory, some or most of the medication is absorbed directly through the cheek and enters the blood stream without deactivation in the liver, making absorption much quicker.

The researchers found that 20 patients with migraines given the proxicam troches experienced a significant reduction in pain in 15 minutes. After an hour, the headache had disappeared in 15 patients, became mild in four and remained unchanged in only one subject. Associated symptoms also quickly disappeared after piroxicam troche administration, and the headache recurred in only two patients within the 24-hour period. Furthermore, the researchers reported that the therapy was well tolerated with only minimal side effects.

It should be noted that the researchers used 40 mg of piroxicam in this study, but the maximum recommended dose approved by the FDA is 20 mg. We have recently used 20 mg troches on two people who suffer from migraines, and their experience mirrors that observed in the original study. This may possibly indicate that 20 mg may be adequate to break the migraine cycle from which many people suffer.

If you or someone you know suffers from migraines, please feel free to contact us regarding this therapy. We are always happy to help relieve someone's pain and suffering.

[1] Giuseppe Nappi M.D., Giuseppe Micieli M.D., Cristina Tassorelli M.D., Elena Viotti M.D. and Teodoro Altavilla M.D. June 1993. Effectiveness of a Piroxicam Fast Dissolving Formulation Sublingually Administered in the Symptomatic Treatment of Migraine Without Aura. Headache: The Journal of Head and Face Pain; 33(6) pp 296-300.