Successful Treatment of Migraine With Antiviral/NSAID Combo

Previous literature has speculated on an association between migraine headache and HSV.

Successful treatment of migraine headache with therapy specifically targeting herpes simplex virus (HSV) infection is highlighted in a new case report published in The Permanente Journal

The case involves a 21-year-old female patient who presented with a severe and throbbing headache that was later diagnosed as acute migraine. Over the course of 3 months she was started on several migraine treatments including triptans, β-blockers, prednisone, and botulinum toxin injections. These provided some relief but she continued to have difficulties with higher cognitive functions which caused her to take a semester off from college. 

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Seven months after her initial presentation, the patient was prescribed famciclovir and celecoxib which provided substantial relief of her symptoms and improved her sleep quality. While taking maintenance doses of these two medications, she was able to resume college coursework as her mental clarity had returned, in addition to continued improvement in headache symptoms. After 12 months of treatment, she discontinued the combination; recent follow-up indicates no increase in migraine frequency or severity.

Previous literature has speculated on an association between migraine headache and HSV.  The authors hypothesize that migraine may be attributable to a reactivation of a latent HSV residing within the trigeminal ganglion. Both famciclovir and celecoxib are known to have direct antiviral activity toward HSV and may work synergistically against the virus. 

Additional trials are needed to better understand the role each agent plays in treating migraine disorder, however, the authors conclude that “On the basis of the current understanding of the pathophysiology of migraine headaches, specifically the role of HSV-mediated trigeminal inflammation in migraine symptomatology and the antiviral characteristics of famciclovir and celecoxib, we believe these medications may work synergistically to treat migraine disorder.”

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