Possible Involvement of Dopaminergic Mechanisms in the Antimigraine Action of Flunarizine

Piccini, Paola; Nuti, Angelo; Paoletti, Anna Maria; Napolitano, Alessandro; Melis, Gian Benedetto; Bonuccelli, Ubaldo

doi:10.1046/j.1468-2982.1990.1001003.x

Cited by 23 publications

(13 citation statements)

References 36 publications

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“…Evidence of dopaminergic hypersensitivity in migraine patients supports the hypothesis of the involvement of monoamines in the underlying mechanism of migraine, and could have implications in its treatment. Flunarizine, a powerful prophylactic drug in migraine, shows a clear antidopaminergic effect (36)(37)(38), and its antimigraine action could depend on this "neuroleptic-like" activity as well as its activity as a calcium antagonist (39).…”

Section: Discussionmentioning

confidence: 99%

Transcranial Doppler Ultrasound in Migraine and Tension-Type Headache after Apomorphine Administration: Double-Blind Crossover versus Placebo Study

Piccini¹,

Pavese²,

Palombo³

et al. 1995

Cephalalgia

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The effect of the dopaminergic agonist apomorphine on blood velocity in the middle cerebral artery has been studied in patients with migraine, tension-type headaches, and healthy subjects by means of transcranial Doppler monitoring. Following the administration of apomorphine, systolic velocity and mean velocity significantly increased and pulsatility index significantly decreased in migraineurs compared to placebo and to the other groups of subjects. These changes were dose-dependent and showed a time-curved compatible with the pharmacokinetic profile of the drug. The different effect of apomorphine in migraineurs compared with controls and tension-type headache patients implies that migraineurs have increased sensitivity to dopaminergic stimuli and suggests that transcranial Doppler monitoring after apomorphine administration could be a useful tool in the evaluation of migraineurs.

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Section: Discussionmentioning

confidence: 99%

Transcranial Doppler Ultrasound in Migraine and Tension-Type Headache after Apomorphine Administration: Double-Blind Crossover versus Placebo Study

Piccini¹,

Pavese²,

Palombo³

et al. 1995

Cephalalgia

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“…Flunarizine is a calcium channel blocker often used as both an acute and prophylactic migraine treatment (79–81) and also appears to have action as a dopamine antagonist, specifically DRD2, although it is not clear whether its antimigraine action is actually via dopaminergic mechanisms (81, 82). Other dopamine antagonists studied in migraine prophylaxis include lisuride, bromocriptine and ergocryptine, none of which is widely regarded as more helpful than flunarizine.…”

Section: Dopamine and Migrainementioning

confidence: 99%

Dopamine and Migraine: Biology and Clinical Implications

2007

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In the last 30 years dopamine has been considered as playing a role in the pathogenesis of migraine. The literature indicates that migraineurs are hypersensitive to dopamine agonists with respect to some of the premonitory symptoms of migraine such as nausea and yawning. There are various non-specific dopamine D(2) receptor antagonists that show good clinical efficacy in migraine, and also a number of polymorphisms of dopaminergic genes related to migraine. Animal studies have also shown that dopamine receptors are present in the trigeminovascular system, the area believed to be involved in headache pain, and neuronal firing here is reduced by dopamine agonists. There appears to be little effect of dopamine on peripheral trigeminal afferents. We assess some of the limitations of the clinical studies with regard to the therapeutics, and those found in the studies that discovered differences in genetic polymorphisms in migraine, and consider the implications of this on a dopaminergic hypothesis of migraine.

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“…Derivados de alcalóides do ergot, como o lisuride, di-hidroergocriptina e bromocriptina apresentam ação sobre os receptores centrais D 2 , reduzindo o número de crises mensais de migrânea [17][18][19] . A flunarizina, um bloqueador de canal de cálcio, bloqueia os receptores dopaminérgicos e tem sido utilizada para o tratamento agudo e profilático da migrânea 20,21 . Em dois estudos independentes, a flunarizina mostrouse ser altamente eficaz no tratamento agudo da migrânea (melhora de 74% e 78%) 20,22 .…”

Section: Discussionunclassified

Mudança no padrão biológico da migrânea com aura após a utilização da tetrabenazina: relato de caso

Piovesan

Lange²,

Teive

et al. 2000

Arq. Neuro-Psiquiatr.

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RESUMO -A participação do sistema dopaminérgico na fisiopatologia da migrânea tem sido proposta a partir de recentes conquistas genéticas. Uma possível hipereatividade dos receptores dopaminérgicos DRD2 tornou as evidências mais contundentes neste sentido. Descrevemos paciente masculino, 31 anos, portador de distonia generalizada, secundária a hipóxia perinatal. Aos 16 anos, começou a ter crises de cefaléia que preenchiam os critérios para migrânea com aura. Três anos após tratamento da distônia com tetrabenazina, observou-se nítida redução da frequência, intensidade e duração das crises. Durante dois períodos, superiores a dois meses, a interrupção do tratamento com tetrabenazina induziu piora nas crises de migrânea. Apresentamos este relato como sendo a primeira descrição na literatura mostrando efeitos benéficos da tetrabenazina, um bloqueador dos receptores dopaminérgicos, sobre o comportamento da migrânea com aura.PALAVRAS CHAVES: dopamina, enxaqueca, profilaxia, tetrabenazina.Change in the biologic pattern of the migraine with aura after the use of tetrabenazine: case report ABSTRACT -The influence of the dopaminergic system on the pathophysiology of migraine has been suggested as a result of recent genetic discoveries. A possible hyper-reactivity of the dopaminergic receptors DRD2 reinforced the evidence regarding this. We describe a 31 years-old male patient affected by a generalized dystonia secondary to perinatal hypoxia. At age 16, the patient started having headache crises that met the criteria for migraine with aura. After three years of treatment for dystonia with tetrabenazine, a clear reduction in the frequency, intensity and duration of the crises was perceived. During two periods longer than two months, the interruption of the treatment with tetrabenazine brought about an aggravation of the migraine crises. We present this case as being the first description in the literature showing the beneficial effects of tetrabenazine, a blocker of dopaminergic receptors, on the behavior of migraine with aura.KEY WORDS: dopamine, migraine, prophylaxis, tetrabenazine. Na migrânea sintomas como náuseas, vômitos e oscilações pressóricas podem ser atribuídos a ativação do sistema dopaminérgico. Em pacientes migranosos tem sido demonstrada hipersensibilidade aos agonistas dopaminérgicos e dos receptores monoaminérgicos 1 . Estudos genéticos em pacientes migranosos mostraram aumento na frequência dos alelos 1, responsáveis

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Possible Involvement of Dopaminergic Mechanisms in the Antimigraine Action of Flunarizine

Cited by 23 publications

References 36 publications

Transcranial Doppler Ultrasound in Migraine and Tension-Type Headache after Apomorphine Administration: Double-Blind Crossover versus Placebo Study

Transcranial Doppler Ultrasound in Migraine and Tension-Type Headache after Apomorphine Administration: Double-Blind Crossover versus Placebo Study

Dopamine and Migraine: Biology and Clinical Implications

Mudança no padrão biológico da migrânea com aura após a utilização da tetrabenazina: relato de caso

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