Nifedipine in the prophylaxis of classic migraine

McArthur, Justin C.; Marek, Kenneth; Pestronk, Alan; McArthur, John D.; Peroutka, S. J.

doi:10.1212/wnl.39.2.284

Cited by 35 publications

(11 citation statements)

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“…The evidence for nifedipine was difficult to interpret. Two comparisons with placebo yielded similar effect sizes that were statistically insignificant, but the 95% confidence intervals associated with these estimates were large and did not exclude either a clinically important benefit or harm associated with nifedipine (128, 129). Similarly ambiguous results were reported in one comparison with flunarizine (130) and two comparisons with propranolol (20, 131).…”

Section: Clinical Trialsmentioning

confidence: 99%

Migraine: Preventive Treatment

Silberstein¹,

2002

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Migraine is a common episodic headache disorder. A comprehensive headache treatment plan includes acute attack treatment to relieve pain and impairment and long-term preventive therapy to reduce attack frequency, severity, and duration. Circumstances that might warrant preventive treatment include: (i) migraine that significantly interferes with the patient's daily routine despite acute treatment; (ii) failure, contraindication to, or troublesome side-effects from acute medications; (iii) overuse of acute medications; (iv) special circumstances, such as hemiplegic migraine; (v) very frequent headaches (more than two a week); or (vi) patient preference. Start the drug at a low dose. Give each treatment an adequate trial. Avoid interfering, overused, and contraindicated drugs. Re-evaluate therapy. Be sure that a woman of childbearing potential is aware of any potential risks. Involve patients in their care to maximize compliance. Consider co-morbidity. Choose a drug based on its proven efficacy, the patient's preferences and headache profile, the drug's side-effects, and the presence or absence of coexisting or co-morbid disease. Drugs that have documented high efficacy and mild to moderate adverse events (AEs) include beta-blockers, amitriptyline, and divalproex. Drugs that have lower documented efficacy and mild to moderate AEs include selective serotonin reuptake inhibitors (SSRIs), calcium channel antagonists, gabapentin, topiramate, riboflavin, and non-steroidal anti-inflammatory drugs.

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Section: Clinical Trialsmentioning

confidence: 99%

Migraine: Preventive Treatment

Silberstein¹,

2002

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“…Beginning in 1981, a variety of clinical studies have demonstrated that calcium channel blockers may be effective in migraine phrophylaxis, although more recent data suggest that these drugs may not be as efficacious as initially reported. 29,30 It should also be stressed that none of these agents has been specifically approved for use in migraine in the United States. In addition, side effects can be expected to develop in up to 60% of the patients and usually consist of constipation, orthostatic hypotension and red, swollen feet.…”

Section: -Ht Receptormentioning

confidence: 99%

The Pharmacology of Current Anti‐Migraine Drugs

Peroutka

1990

Headache

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The major finding of this analysis is that acute anti-migraine agents (e.g., ergots, sumatriptan) share high affinity for 5-HT1D receptors. This receptor appears to be present in certain intracranial blood vessels. It is also found on nerve terminals where it inhibits the release of 5-HT and other neurotransmitters. Theoretically, 5-HT1D receptor agonists may acutely inhibit the release of vasoactive and/or pain-inducing substances in the perivascular space. Conceivably, drugs acting at this receptor would stop the progression of this perivascular process. In contrast, a number of prophylactic anti-migraine drugs share a relatively high affinity for 5-HT2 receptors in human brain. Although this receptor is also found in certain blood vessels, it is present throughout the nervous system. The receptor appears to mediate neuronal depolarizations at the cellular level. No hypothesis, at present, readily explains the effectiveness of prophylactic anti-migraine drugs based on this receptor. These data offer a novel approach to the analysis of anti-migraine agents. Drugs could be selected for use in clinical migraine studies based on their selectivity for a specific 5-HT receptor subtype. "Pure" drugs could be chosen which would essentially limit the number of possible sites of action for the drugs. For example, an agent which displays both high affinity and selectivity for 5-HT1D receptors could be clinically evaluated. Its effectiveness, or lack thereof, would indicate the importance of the specific 5-HT receptor site in the pathogenesis of migraine. Further attempts to determine a common mechanism of action for effective anti-migraine agents should facilitate the elucidation of the pathogenesis of this neurological syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…25 A high incidence of vascular side effects has also been reported in other studies of nifedipine in migraine. 4,14 This suggests that migraine patients may be particularly sensitive to nifedipine induced vasodilatation. This could be explained by an underlying defect in vasomotor control in migraine patients.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10] However, there are only a few reports based on small numbers of patients which address the effectiveness of nifedipine for migraine. 4,[11][12][13][14] The goal of the present study was to compare the effectiveness of nifedipine to that of propranolol in the initial prophylaxis of migraine headache. Pro-pranolol was chosen as the comparison agent for nifedipine since it has been consistently demonstrated to be effective in approximately 50 to 75% of migraineurs.…”

Section: Introductionmentioning

confidence: 99%

Nifedipine Versus Propranolol for the Initial Prophylaxis of Migraine

et al. 1989

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We conducted a randomized open-labeled study of nifedipine versus propranolol for the initial prophylaxis of migraine. Propranolol was effective in 67% of patients (12/18) and well tolerated. Nifedipine was effective in only 30% of patients (6/20). The lack of overall efficacy of nifedipine was attributable to a high incidence of side effects, including an unusual symptom complex resembling erythromelalgia. These side effects led 45% (9/20) of the nifedipine patients to withdraw from the study within two weeks. By contrast, no patient (0/18) withdrew from the study within the first 2 weeks of propranolol therapy. We conclude that nifedipine is not an agent of first choice for the prophylaxis of migraine.

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Nifedipine in the prophylaxis of classic migraine

Cited by 35 publications

References 0 publications

Migraine: Preventive Treatment

Migraine: Preventive Treatment

The Pharmacology of Current Anti‐Migraine Drugs

Nifedipine Versus Propranolol for the Initial Prophylaxis of Migraine

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