Nifedipine Versus Propranolol for the Initial Prophylaxis of Migraine

Albers, Gregory W.; Simon, Lynn T.; Hamik, B A Anne; Peroutka, Stephen J.

doi:10.1111/j.1526-4610.1989.hed22904215.x

Cited by 32 publications

(8 citation statements)

References 18 publications

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“…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). One trial found that metoprolol was significantly better than nifedipine at reducing headache frequency (20).…”

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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“…Such studies have failed to demonstrate therapeutic effects beyond placebo, e.g. for selective 5‐HT reuptake inhibitors [14], MAO‐B inhibitors [15], antiepileptic drugs such as carbamazepine [16] and lamotrigine [17], or calcium entry blockers such as nimodipine [18], nifedipine [19], and most recently cyclandelate [20]. Although the ergot alkaloid dihydroergotamine has been used for prophylactic treatment, there is no good evidence for its efficacy in this indication.…”

Section: Therapeutic Options For Prophylactic Migraine Treatmentmentioning

confidence: 99%

“…Based on these comparative studies as well as the placebo‐controlled trials (for reviews see [24, 25]), flunarizine is considered a drug of first choice in migraine prophylaxis. In the light of the negative results with other calcium entry blockers [19, 20], it remains to be determined whether the prophylactic efficacy of flunarizine is related to its calcium entry blocking properties.…”

Section: Other Prophylactic Antimigraine Drugs In Comparison With β‐Amentioning

confidence: 99%

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The prevention of migraine: a critical review with special emphasis on β‐adrenoceptor blockers

Limmroth

Michel

2001

Brit J Clinical Pharma

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hand, it appears that other b-adrenoceptor blockers, perhaps with the exception of those with intrinsic sympathomimetic activity, can be equally effective. Uncertainties regarding the relative merits of various treatment modalities are largely caused by lack of adherence to speci®c requirements for clinical trials on migraine prophylaxis. Therefore, this article reviews internationally recommended conditions for reliable studies on migraine prophylaxis and appraises individual agents in the light of these criteria.

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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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Nifedipine Versus Propranolol for the Initial Prophylaxis of Migraine

Cited by 32 publications

References 18 publications

Migraine: Preventive Treatment

Migraine: Preventive Treatment

The prevention of migraine: a critical review with special emphasis on β‐adrenoceptor blockers

The Pharmacology of Current Anti‐Migraine Drugs

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