Could Statins Be Useful in the Treatment of Patients With Migraine?

Abstract

Migraine is a common and disabling neurological disorder. Studies have shown that patients with migraine (especially those with typical aura with migraine) have an unfavorable cardiovascular risk profile and an increased risk of early-onset (<45 years) ischemic stroke. Statins are effective hypolipidemic drugs that reduce cardiovascular-related morbidity and death in patients with or without established atherosclerotic vascular disease. We report a patient whose frequent attacks of typical aura with migraine completely resolved after the initiation of treatment with a statin. In this context, we comment on the possible effects of statins on the pathophysiology of migraine. We suggest that statins may be useful drugs in the treatment of migraine because they could reduce the increased cardiovascular risk in these patients and also attenuate migraine attacks. Only a randomized prospective study in this population could provide a definite answer to these speculations.

Statins Decrease Expression of the Proinflammatory Neuropeptides Calcitonin Gene-Related Peptide and Substance P in Sensory Neurons

“…Recent clinical and experimental observations suggest that statins may be useful in the treatment of diseases with a primary component of neurogenic inflammation (Leung et al, 2003;McKay et al, 2004;Abeles and Pillinger, 2006;Liberopoulos and Mikhailidis, 2006;Gazi et al, 2007;Kim et al, 2007). In this study, we describe a novel action of statins that may contribute to these therapeutic effects: their ability to decrease the expression of CGRP and substance P, the proinflammatory neuropeptides released by sensory neurons that trigger neurogenic inflammation.…”

“…In light of the increasing evidence that these proinflammatory neuropeptides play a central role in the pathophysiology of diseases with a predominant neurogenic inflammation component, such as migraine headache (Geppetti et al, 2005;Durham, 2006;Unger, 2006), rheumatoid arthritis (O'Connor et al, 2004;Bring et al, 2005), and reactive airway diseases (Carr and Undem, 2001;Springer et al, 2003;Groneberg et al, 2004;O'Connor et al, 2004), our data suggest the intriguing possibility that statin modulation of CGRP and substance P expression may be effective in preventing or attenuating neurogenic inflammation. Although recent reports suggest that statins are useful in the treatment of migraine headache (Liberopoulos and Mikhailidis, 2006), rheumatoid arthritis (Leung et al, 2003;Abeles and Pillinger, 2006;Gazi et al, 2007), and reactive airway diseases (McKay et al, 2004;Kim et al, 2007), future studies using neurobehavioral models of neurogenic inflammation are required to determine whether down-regulated expression of proinflammatory neuropeptides contributes to these therapeutic actions.…”

“…Recent clinical and experimental observations suggest that statins may also be efficacious in the treatment of diseases linked to neurogenic inflammation, specifically migraine headache (Liberopoulos and Mikhailidis, 2006), rheumatoid arthritis (Leung et al, 2003;Abeles and Pillinger, 2006;Gazi et al, 2007), and reactive airway diseases (McKay et al, 2004;Kim et al, 2007). The authors of these studies postulated that the therapeutic actions of statins in these diseases were attributable to their known vascular and anti-inflammatory effects (Leung et al, 2003;McKay et al, 2004;Abeles and Pillinger, 2006;Liberopoulos and Mikhailidis, 2006;Gazi et al, 2007;Kim et al, 2007), but whether statins also interfere directly with cellular and molecular mechanisms of neurogenic inflammation has not been addressed.…”

C-reactive protein and migraine. Facts or speculations?

“…Interestingly, Liberopoulos et al first described the case of a 58-year-old man with peripheral arterial disease and hyperlipidemia, whose frequent attacks of migraine with aura completely disappeared after therapy with atorvastatin 20 mg/day [35]. Medeiros et al also recently described the results of an open-label, prospective, parallel group, active comparator study of simvastatin versus propranolol for the prophylactic treatment of migraine in 54 women (aged 18-45 years) with more than six migraine attacks per month [36].…”

Vascular Risk Factors, Endothelial Function, and Carotid Thickness in Patients with Migraine: Relationship to Atherosclerosis

“…Their beneficial effect has been attributed to their lipid-lowering and anti-inflammatory effects. 40 …”