Take a quick minute to see how many facts you may already know.
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Acute migraine is a painful neurovascular phenomenon characterized by episodic activation of which one of the following:
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  • High levels of 5-hydroxytryptamine
  • The trigeminal vascular system
  • The lymphatic system
  • NMDA receptors
CORRECT ANSWER: Activation of the trigeminal vascular system causes vasodilation and neurogenic inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) may have the potential to suppress the neurogenic inflammatory response.1
The trigeminal vascular system
Which of the following is NOT 1 of the 4 phases of migraine?
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  • The prodrome phase, which occurs hours or days before the headache
  • The autosomal phase, which immediately precedes the headache
  • The pain phase, also known as headache phase
  • The postdrome phase, the effects of which are experienced following the end of a migraine attack
CORRECT ANSWER: The phase that immediately precedes the headache is called the aura phase. Only about 25% of migraine patients experience this phase, which can cause a variety of symptoms and changes in vision, such as brief flashes of lights, blank or tiny blind spots, or partial loss of sight. Some people may also experience auditory or olfactory hallucinations.2
The autosomal phase, which immediately precedes the headache
On average, what percentage of migraine patients do you think typically report stopping or discontinuing their migraine medication because of side effects?
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  • 45%
  • 55%
  • 65%
  • 75%
CORRECT ANSWER: 65% of patients typically report stopping or discontinuing their migraine medication because of side effects, such as nausea, vomiting, stomachache, rebound headache, and dizziness.3
65%
Of the 39 million Americans suffering from migraine in 2017,4 what percentage are dissatisfied with their migraine medication?
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  • 15%
  • 42%
  • 58%
  • 80%
CORRECT ANSWER: 42% of patients are not satisfied with their migraine medication. Specifically, 37% of patients are dissatisfied with the speed of their migraine treatment and almost 80% of migraine patients are willing to try another treatment.5
42%
Diclofenac, including diclofenac potassium for oral solution, has been established as having Level A evidence for the treatment of migraine—the highest rating by the American Headache Society.
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  • True
  • False
CORRECT ANSWER: AHS 2015 Assessment stated that the use of diclofenac for the acute treatment of migraine was supported by Level A evidence based on the review of 4 Class I studies.6

INDICATIONS AND USAGE

CAMBIA® (diclofenac potassium) for oral solution is indicated for the acute treatment of migraine attacks with or without aura in adults (18 years of age or older).

Limitations of Use:

  • CAMBIA is not indicated for the prophylactic therapy of migraine.
  • The safety and effectiveness of CAMBIA have not been established for cluster headache.

IMPORTANT SAFETY INFORMATION

WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS

Cardiovascular Thrombotic Events

  • Non-steroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction, and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. 
  • CAMBIA is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

Gastrointestinal Bleeding, Ulceration, and Perforation

  • NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.
True
In addition to pain associated with acute migraine attacks in adults, which of the following symptoms associated with migraine does CAMBIA also treat?
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  • Nausea
  • Photophobia
  • Phonophobia
  • All of the above
CORRECT ANSWER:

According to the International Headache Society, to be diagnosed with migraine, a patient must experience pain PLUS at least one of the following symptoms during headache: nausea and/or vomiting, photophobia, and phonophobia. CAMBIA has shown to provide improvement within 2 hours of nausea, photophobia, and phonophobia.7

CAMBIA provided pain-free response at 2 hours8-10

The efficacy of a single dose of CAMBIA 50 mg in the treatment of migraine headache was demonstrated in 2 randomized, double-blind, placebo-controlled trials.8

CAMBIA treats multiple symptoms at 2 hours10

The efficacy of a single dose of CAMBIA 50 mg in the treatment of migraine headache was demonstrated in 2 randomized, double-blind, placebo-controlled trials.8

DOSAGE AND ADMINISTRATION

Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals. The safety and effectiveness of a second dose have not been established.

Non-Interchangeability with Other Formulations of Diclofenac

Different formulations of oral diclofenac are not bioequivalent even if the milligram strength is the same. Therefore, it is not possible to convert dosing from any other formulation of diclofenac to CAMBIA.

All of the above
In a European clinical study conducted by Diener, how quickly did a single dose of 50-mg CAMBIA start working compared to diclofenac potassium tablets, which was 60 minutes?
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  • 5 minutes
  • 15 minutes
  • 30 minutes
  • 45 minutes
CORRECT ANSWER: In the Diener study,* CAMBIA delivered onset of analgesic effect in 15 minutes compared to 60 minutes for diclofenac potassium immediate-release tablets.9

The efficacy of a single dose of CAMBIA 50 mg in the treatment of migraine headache was demonstrated in 2 randomized, double-blind, placebo-controlled trials.8

*Time to onset of analgesic effect was defined as the first point at which there was a statistically significant difference on the visual analogue scale as compared to placebo. In patients treated with CAMBIA, this was 15 minutes (P≤.05 versus placebo); in patients treated with diclofenac tablets, this was 60 minutes (P≤.05 versus placebo).9

Analgesic effect based on time point to first statistically significant difference in visual analogue scale score or pain intensity score of active therapy over placebo for headache intensity.


CONTRAINDICATIONS

CAMBIA is contraindicated in the following patients:

  • Known hypersensitivity (e.g., anaphylactic reactions and serious skin reactions) to diclofenac or any components of the drug product
  • History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients.
  • In the setting of coronary artery bypass graft (CABG) surgery.
15 minutes
Eligible patients pay no more than $_____ for a CAMBIA prescription when they enroll in the CAMBIA Savings Program.
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  • $40
  • $30
  • $20
  • $10
CORRECT ANSWER:

All your patient has to do is bring a printout of their savings card with their CAMBIA prescription to their pharmacist. The savings card can be downloaded from the CAMBIA website here.

Terms and Conditions

  • Offer applies to out-of-pocket expenses (copay) greater than $20. Out-of-pocket expenses greater than $20 will be covered up to $110 per prescription. If your total out-of-pocket cost exceeds $110, you will be responsible for a $20 copay plus any additional amount over $110. If your copay is already $20 or less, this offer does not apply.
  • This offer is not valid for prescriptions paid in part or in full by any federally or state funded program, including but not limited to Medicaid, Medicare, Department of Veterans Affairs, Department of Defense, or TRICARE, and where prohibited by law.
  • This savings program cannot be combined with any other coupon, certificate, voucher, or similar offer.
  • Offer not extended to clubs, groups, or organizations.
  • Participation in this program must comply with all applicable laws and contractual or other obligations as a pharmacy provider.
  • This is not an insurance program.
  • Participating patients and pharmacists understand and agree to comply with the Terms and Conditions of this offer as set forth herein.
  • Any step-edits or prior authorizations required by the insurance plan still apply.
  • This offer is void where taxed, restricted, or prohibited by law.
  • This offer is limited to one card per patient.
  • Depomed, Inc. reserves the right to modify or cancel this program at any time.
  • eVoucherRx is not extended on prescriptions for patients:
    • Who are cash-paying customers
    • Using mail-order or institution-based pharmacies to fill their prescriptions, or who are federal or state government employees
    • Who are filling their prescriptions at nonparticipating pharmacies
$20

References

1. Waeber C, Moskowitz MA. Migraine as an inflammatory disorder. Neurology. 2005;64(10, suppl 2):S9-S15. 2. Robert T. Migraine phases. Migraine.com. https://migraine.com/migraine-basics/migraine-phases/. Reviewed August 2014. Accessed November 14, 2017. 3. Migraine in America 2012. Treatment side effects. https://migraine.com/mia2012/treatment-side-effects/. Accessed April 5, 2017. 4. Migraine Research Foundation. Migraine facts. http://migraineresearchfoundation.org/about-migraine/migraine-facts/. Accessed April 11, 2017. 5. Bigal M, Rapoport A, Aurora S, Sheftell F, Tepper S, Dahlof C. Satisfaction with current migraine therapy: experience from 3 centers in US and Sweden. Headache. 2007;47(4):475-479. 6. Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache. 2015;55(1):3-20. 7. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808. 8. CAMBIA [package insert]. Newark, CA: Depomed, Inc; 2017. 9. Diener HC, Montagna P, Gács G, et al. Efficacy and tolerability of diclofenac potassium sachets in migraine: a randomized, double-blind, cross-over study in comparison with diclofenac potassium tablets and placebo. Cephalalgia. 2006;26(5):537-547. 10. Lipton RB, Grosberg B, Singer RP, et al. Efficacy and tolerability of a new powdered formulation of diclofenac potassium for oral solution for the acute treatment of migraine: results from the International Migraine Pain Assessment Clinical Trial (IMPACT). Cephalalgia. 2010;30(11):1336-1345.