flunarizine and Migraine-with-Aura

Novel disease-specific and mechanism-based treatments sharing good evidence of efficacy for migraine have been recently marketed. However, reimbursement by insurers depends on treatment failure with classic anti-migraine drugs. In this systematic review and meta-analysis, we aimed to identify and rate the evidence for efficacy of flunarizine, a repurposed, first- or second-line treatment for migraine prophylaxis.. A systematic search in MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov was performed for trials of pharmacological treatment in migraine prophylaxis, following the Preferred Reporting Items for Systematic Reviews (PRISMA). Eligible trials for meta-analysis were randomized, placebo-controlled studies comparing flunarizine with placebo. Outcomes of interest according to the Outcome Set for preventive intervention trials in chronic and episodic migraine (COSMIG) were the proportion of patients reaching a 50% or more reduction in monthly migraine days, the change in monthly migraine days (MMDs), and Adverse Events (AEs) leading to discontinuation.. Five trials were eligible for narrative description and three for data synthesis and analysis. No studies reported the predefined outcomes, but one study assessed the 50% reduction in monthly migraine attacks with flunarizine as compared to placebo showing a benefit from flunarizine with a low or probably low risk of bias. We found that flunarizine may increase the proportion of patients who discontinue due to adverse events compared to placebo (risk difference: 0.02; 95% CI -0.03 to 0.06).. Published flunarizine trials predate the recommended endpoints for evaluating migraine prophylaxis drugs, hence the lack of an adequate assessment for these endpoints. Further, modern-day, large-scale studies would be valuable in re-evaluating the efficacy of flunarizine for the treatment of migraines, offering additional insights into its potential benefits.

Topics: Flunarizine; Headache; Humans; Migraine Disorders; Migraine with Aura; Research Design; Transcription Factors

Many studies have already reported encouraging results in the prophylactic therapy of migraine by acupuncture, but there seems to be a lack of high quality randomized controlled trials from China. We design and perform a randomized controlled clinical trial to evaluate the efficacy of acupuncture compared with flunarizine in the prophylactic therapy of patients with migraine without aura in China.. This trial is a multicenter, prospective, randomized controlled clinical trial. The 140 migraine patients are randomly allocated to two different groups. The acupuncture groups (n = 70) is treated with acupuncture and placebo medicine; while the control group (n = 70) is treated with sham acupuncture and medicine (Flunarizine). Both Flunarizine and placebo are taken 10 mg once per night for the first 2 weeks and then 5 mg once per night for the next 2 weeks. Patients in both groups receive 12 sessions of verum/sham acupuncture in 4 weeks.. The study design and the long term clinical practice of acupuncturists guarantee a high external validity for the results. The results of our trial will be helpful to supply the evidence on the efficacy of acupuncture for migraine prophylaxis in China.

Topics: Acupuncture Therapy; Adolescent; Adult; Aged; Calcium Channel Blockers; China; Clinical Protocols; Female; Flunarizine; Humans; Male; Middle Aged; Migraine with Aura; Prospective Studies; Research Design; Treatment Outcome; Young Adult

Familial hemiplegic migraine (FHM) is a rare, autosomal dominant migraine with aura. CACNA1A encodes the α1A subunit of P/Q-type voltage-gated calcium channels, and its mutations have been associated with a wide spectrum of episodic and chronic neurological disorders, including FHM type 1 (FHM1).. A Chinese girl and some of her relatives who presented with hemiplegia with or without migraine were found to carry a novel heterozygous missense variant, I1379F, in CACNA1A by whole-exome sequencing. The variant consegregated with the disease and was predicted to be pathogenic.. The patient was diagnosed with FHM1 clinically and genetically.. Prophylactic therapy with flunarizine 5 mg daily was prescribed to the patient.. Therapy with flunarizine was terminated after a few weeks. The intensity of the attacks was the same as before.. This case indicates that FHM should be considered when a patient manifests with episodic hemiplegia without migraine. In addition, genetic testing is an indispensable method to identify atypical attacks of hemiplegic migraine.

Topics: Calcium Channels; Cerebellar Ataxia; Female; Flunarizine; Humans; Migraine Disorders; Migraine with Aura; Pedigree

Topics: Celecoxib; Female; Flunarizine; Humans; Middle Aged; Migraine with Aura

In this work, we describe an association of brainstem headache with aura (BHA) and Alice in Wonderland syndrome (AIWS) in a 17-year-old male, suffering from crises of vertigo, weakness, dysarthria, and diplopia, in half-hour duration, followed by diffuse or occipital headache, lasting several hours.. The frequency of the attacks was monthly, and once there was short loss of consciousness. The last episodes were accompanied by symptoms such as deformation of figures and objects, small or large in shape.. Diagnostic examinations were performed, mainly neuroimaging tests such as brain MRI and brain angio-MRI, all resulting normal; and treatment with flunarizine was followed by improvement of both BHA and AIWS symptoms.. There would be a correlation between BHA and AIWS, presumably represented by dysfunction of temporo-parieto-occipital carrefour.

Topics: Adolescent; Alice in Wonderland Syndrome; Anticonvulsants; Brain Stem; Flunarizine; Humans; Male; Migraine with Aura

We report a 27-year-old woman, a known case of classical migraine headache, on oral contraceptive pills. She had a severe episode of migraine with visual aura attack, which continued late into the night. The next early morning, her headache persisted and she developed abrupt onset of dysarthria, right hemiparaesthesias. She attributed symptoms to her long-standing headache problem, and hence did not seek medical help for the next two weeks. The symptoms persisted despite her headache subsiding over the next 24 hours. She worsened 2 weeks later during another such episode of headache. This time, she developed right hemiparesis. The patient was admitted with provisional diagnosis of stroke. MRI of the brain showed left temporoparietal lesion and was radiologically compatible with cortical laminar necrosis.Extensive work-up was done to rule out other causes of young stroke. The patient improved with antiplatelets, antimigraine prophylaxis and stroke rehabilitation therapy.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Aspirin; Cerebral Cortex; Cerebral Infarction; Diagnosis, Differential; Female; Flunarizine; Fructose; Humans; Magnetic Resonance Imaging; Migraine with Aura; Naproxen; Necrosis; Stroke Rehabilitation; Topiramate

Topics: Drug-Related Side Effects and Adverse Reactions; Female; Flunarizine; Humans; Male; Migraine with Aura; Pediatrics; Vasodilator Agents

The aim of this study was to report a single-centre experience of flunarizine in childhood migraine with focus on safety and efficacy.. We conducted a retrospective observational audit of 72 individuals (40 male, 32 female; mean age 13y; age range 1y 6mo-17y) at a tertiary paediatric neurology unit between 1998 and 2009. Children were included if they had a diagnosis of migraine and at least one follow-up assessment and a minimum of 3 months' treatment with flunarizine.. Of 102 individuals identified, 30 were excluded for the following reasons: no outcome data (n=13), non-migraineurs (n=9), missing records (n=4), or inadequate treatment duration (n=4). Of the final cohort (72 individuals), 44 had migraine without aura, 15 had migraine with aura or childhood migraine equivalents, eight had sporadic hemiplegic migraine, and five had familial hemiplegic migraine. The median age was 13 years (1y 6mo-17y) and median duration of migraine was 48 months. Starting dose was 5mg. Other doses used were 2.5mg (three individuals), 7.5mg (one individual), and 10mg (six individuals). Treatment duration was 12 months. Successful prophylaxis, defined as at least a 50% reduction in attack frequency, was observed in 57% (41/72). Response rate was higher among those with hemiplegic migraines (85%) than in those who did not have hemiplegic migraines (51%). Side effects were noted in 15 (21%) individuals (depression, n=6; weight gain/increased appetite, n=5; tiredness/sedation, n=2; and worsening headache, n=2), and led to discontinuation of treatment in 13.. In our cohort of children with migraine, flunarizine appears to be more effective in the hemiplegic migraine group. Adverse effects were seen in one-fifth of the individuals, leading to discontinuation in 18%.

Topics: Adolescent; Child; Child, Preschool; Drug-Related Side Effects and Adverse Reactions; Female; Flunarizine; Humans; Infant; Longitudinal Studies; Male; Migraine with Aura; Pediatrics; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Vasodilator Agents

Hemiplegic migraine is a rare form of migraine characterized by periodic attacks of migraine with neurologic aura and transient hemiplegia. There are familial and sporadic cases, both on a genetic basis; we describe the case of a 6-year-old boy affected by sporadic hemiplegic migraine, showing a novel ATP1A2 gene missense mutation (p.Gly715Arg) in exon 16. Long-term treatment with flunarizine resulted in good clinical response and prevention of further attacks.

Topics: Anticonvulsants; Child; Flunarizine; Hemiplegia; Humans; Migraine with Aura; Mutation, Missense; Sodium-Potassium-Exchanging ATPase; Treatment Outcome

During the past few decades, much controversy has surrounded the pathophysiology of migraine. Cortical spreading depression (CSD) is widely accepted as the neuronal process underlying visual auras. It has been proposed that CSD can also cause the headaches, at least in migraine with aura. We describe three patients, each fulfilling the International Headache Society criteria for migraine with aura, who suffered from headaches 6-10 days per month. Two patients were treated with flunarizine and the third patient with topiramate for the duration of 4 months. All patients reported that aura symptoms resolved completely, whereas the migraine headache attacks persisted or even increased. These observations question the theory that CSD (silent or not) is a prerequisite for migraine headaches.

Topics: Adolescent; Brain; Cortical Spreading Depression; Female; Flunarizine; Fructose; Humans; Middle Aged; Migraine with Aura; Migraine without Aura; Topiramate

The pathogenesis of migraine with aura has not been fully established yet. The release of vasoactive substances and intracranial extracerebral blood vessel vasodilatation are probably related to stimulation of meningeal blood vessels through trigeminal afferents. Here, we report a 67 year old woman developing migraine with aphasia and right hemianopsia, lasting 4 days in duration. After spontaneous recovery, she experienced the same symptoms without migraine lasting for 15 h. MRI, performed during this last episode, revealed increased perfusion and leakage of contrast into subarachnoid space. In migraine with prolonged aura hyperperfusion with vasogenic edema might explain cortical function impairment and contribute to neurological deficits.

Topics: Aged; Aphasia; Brain; Contrast Media; Female; Flunarizine; Follow-Up Studies; Functional Laterality; Hemianopsia; Humans; Migraine with Aura; Subarachnoid Space; Time Factors; Vasodilator Agents

We present the case of 48-year-old woman suffering from migraine with aura (MA) since menarche. During her life the patient frequently presented catamenial MA attacks with an increasing frequency during pregnancy in particular in the second and third trimesters, and then during breast-feeding. Treatment with oral contraceptive (OC) for endometriosis and later with cyclophosphamide, methotrexate, fluorouracil (CMF) for breast cancer produced a higher number of attacks. Instead, she referred an improvement with gonadotropin releasing hormone agonist (GnRH-a) for the treatment of endometriosis and then with tamoxifen as hormonal therapy after mastectomy and chemotherapy for breast cancer. We highlight the importance of physiological hormonal modification and hormonal therapies on the course of MA.

Topics: Amitriptyline; Analgesics; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Contraceptives, Oral, Hormonal; Cyclophosphamide; Endometriosis; Female; Flunarizine; Fluorouracil; Gonadotropin-Releasing Hormone; Humans; Methotrexate; Middle Aged; Migraine with Aura; Pregnancy; Selective Estrogen Receptor Modulators; Tamoxifen; Triptorelin Pamoate

In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour-coded sonography (c-TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c-TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c-TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.

Topics: Adult; Anticoagulants; Brain; Calcium Channel Blockers; Cardiac Surgical Procedures; Cohort Studies; Cross-Sectional Studies; Echocardiography, Transesophageal; Female; Flunarizine; Heart Septal Defects, Atrial; Humans; Italy; Magnetic Resonance Imaging; Male; Middle Aged; Migraine with Aura; Predictive Value of Tests; Prevalence; Ultrasonography, Doppler, Transcranial