Flunarizine in migraine‐related headache prevention: results from 200 patients treated in the UK

Karsan, Nazia; Palethorpe, David; Rattanawong, Wanakorn; Marin, Juana; Bhola, Ria; Goadsby, PJ

doi:10.1111/ene.13621

Cited by 34 publications

(21 citation statements)

References 28 publications

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“…In our study, the calcium-channel blocker flunarizine was the most commonly prescribed preventive, used by 87.6% of patients receiving preventives. The preferential use of flunarizine over other migraine preventives in China may reflect its relatively mild adverse effects, which can include fatigue, weight gain, and mood changes [32]. Approximately one quarter of patients in our study were prescribed Chinese patent medicine and over 11% were prescribed Chinese herbal medicine.…”

Section: Discussionmentioning

confidence: 91%

Migraine treatment and healthcare costs: retrospective analysis of the China Health Insurance Research Association (CHIRA) database

Zhang

Yao

et al. 2020

J Headache Pain

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Background: Adult migraine remains underdiagnosed and undertreated, despite significant negative effects on physical and emotional functioning. Information on prescribing patterns and treatment costs of migraine in China is limited. Methods: This retrospective analysis of the China Health Insurance Research Association (CHIRA) medical insurance claims database in 2016 to 2017 evaluated treatment patterns, direct medical costs, and healthcare resource utilization among adults with migraine in mainland China. Results: Of 108,375 patients with headache-related outpatient visits, 10,652 were adults with migraine (mean age 51.4 years, 55.4% female). Common comorbidities were major depressive disorder (4.1%), insomnia (3.8%), and anxiety (2.3%). Migraine patients were prescribed acute medication (26.4%), preventive medication (15.0%), and Chinese patent and herbal medicines (24.5% and 11.7%, respectively). Of patients prescribed acute medication, 68.8% received non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs), 7.1% received opioids, while only 3.3% received triptans. Mean annual outpatient costs per patient were 46.5 United States dollars (USD), with mean (standard deviation) 1.8 (2.0) outpatient visits per year. Medication costs for traditional Chinese medicine (22.4 USD per patient) were higher than for Western medicine (13.5 USD). Conclusion: Among migraine patients in China, NSAIDs were commonly prescribed as acute medication, while utilization of migraine-specific triptans and preventive medications was low.

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Section: Discussionmentioning

confidence: 91%

Migraine treatment and healthcare costs: retrospective analysis of the China Health Insurance Research Association (CHIRA) database

Zhang

Yao

et al. 2020

J Headache Pain

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“…Unfortunately, dosages were not specified. Flunarizine (Sibilium ® ) is used as a migraine preventive, but the effect has not been investigated in CH. Only 1 case is described in which the patient suffered from concomitant epilepsy, however, complete termination of attacks was achieved with flunarizine treatment.…”

Section: Resultsmentioning

confidence: 99%

Verapamil and Cluster Headache: Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives

et al. 2019

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Objective A evaluation of the effect of verapamil and other calcium channel blockers in cluster headache (CH) treatment and an investigation of possible effect mechanisms. Background Verapamil has been used in the prevention of CH for almost 3 decades, however, the mode of action and therapeutic target is still unknown. Methods A Pubmed search was conducted: “Verapamil”[Mesh] and “Cluster Headache”[Mesh]. We identified 5 relevant studies for CH. Publications were included if they made a substantial contribution within 3 prespecified areas: Efficacy (randomized controlled‐trials or open labels studies), safety, and mechanism of effect. Results Clinical effect: Clinical preventive treatment of CH with verapamil is based on 2 randomized controlled studies and 3 open‐label studies. In total, 183 CH patients participated. Verapamil 360 mg/day was used in both controlled studies. Half of the chronic patients experienced benefit from verapamil treatment and the attack burden of episodic patients was, on average, reduced by 1 attack/day. Open‐label studies support a dose‐dependent level of efficacy. Mechanism of effect: Human and animal studies indicate that verapamil may exert its effect by modulating circadian rhythms, perhaps in central pacemakers, and/or by affecting release of calcitonin gene‐related peptide. Conclusion Verapamil appears to be an effective prophylactic drug in the treatment of CH and despite the scarcity of controlled trials, it is still the drug of choice. A chronotherapeutic approach might increase the effect. More basic and pharmacokinetic research is needed before the mechanism can be fully understood.

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“…Doses up to 15 mg were generally well tolerated, with only 10.5% (n = 21) of the patients discontinuing treatment because of adverse effects. The most common adverse effects were fatigue (18%), mood change (17%), and weight gain (16%); other less common side effects included tremor (4.5%), dizziness (4%), constipation (2.5%), and nausea (2%) (Karsan et al, 2018). Physicians should carefully weigh the efficacy and adverse effects of This study has certain limitations that should be considered while interpreting the results.…”

Section: Discussionmentioning

confidence: 99%

Flunarizine Induced Parkinsonism in Migraine Group: A Nationwide Population-Based Study

Lin

Hsu

et al. 2019

Front. Pharmacol.

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Background: Flunarizine (Fz) is a first-line prophylactic medication that is widely used in migraine. However, Fz has been recognized as a potential cause of drug-induced parkinsonism for a long time. However, to our knowledge, there has been no population-based subgroup analyses for Fz-induced parkinsonism (FIP) in migraine patients. Methods: Data were obtained from the Taiwan's National Health Insurance Research Database. The study comprised 6,470 migraine patients who were divided into two groups, based on their exposure or non-exposure to Fz. Results: During the study period (2000-2012), the incidence rate of parkinsonism was 1.92 and 8.72 per 1,000 person-years in the control and Fz-treated groups, respectively. In the study population, the adjusted hazard ratio was 4.07 (95% confidence interval CI: 2.84-5.85). In 45-64-year old subjects and ≥ 65-year old subjects, the risk of FIP was 3.18 times (95% CI = 1.63-6.20) and 4.89 times (95% CI = 3.09-7.72) more than that in the controls. The Fz-treated subjects with comorbidities also had a higher risk (4.54, 95% CI: 3.14-6.57). An average annual cumulative Fz dose > 445 mg was accompanied by the greatest risk of FIP; Fz use for >60 days is a cutoff point for predicting future FIP. Conclusion: At the population level, this study showed a complete picture of FIP in migraine patients. FIP is associated with older age, history of comorbidities, exposure to high-dose of Fz, and longer duration of exposure to Fz.

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Flunarizine in migraine‐related headache prevention: results from 200 patients treated in the UK

Abstract: The data provide supportive evidence from tertiary headache practice in the UK for the use of flunarizine in migraine. The data encourages development of future guidance regarding flunarizine use in headache centres in countries where its use is not routine.

Cited by 34 publications

References 28 publications

Migraine treatment and healthcare costs: retrospective analysis of the China Health Insurance Research Association (CHIRA) database

Migraine treatment and healthcare costs: retrospective analysis of the China Health Insurance Research Association (CHIRA) database

Verapamil and Cluster Headache: Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives

Flunarizine Induced Parkinsonism in Migraine Group: A Nationwide Population-Based Study

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