Abstract
This was a double-blind clinical trial designed to assess the efficacy and safety of the cinnarizine (CIN) in patients with migraine who were refractory to propranolol and tricyclic antidepressants in comparison with sodium valproate (SV) to investigate whether CIN could be at least as effective as SV. A total of 125 patients were treated in a treatment period of 12 weeks. All patients had at least one intake of trial medication and 2-week post baseline efficacy observation which all were included in the ITT analysis. Of the 125 subjects treated, 46 discontinued prematurely: 25 from the CIN and 21 from the SV group. The main reasons for premature discontinuation were: lost to follow up (25/46, 63.2%), insufficient response (16/46, 20%), and adverse events (5/46, 12.8%). No statistically significant inter-group differences in the number of discontinuation was observed (p > 0.05). In both groups, number of attacks, intensity, and duration of attacks significantly decreased (p < 0.05). No statistically significant inter-group differences were observed regarding the mean number of attacks, duration, and intensity of migraine attacks for any of the time intervals analysed, except for the mean reduction of third and fourth visits intensity from baseline which were significantly different in two groups (p < 0.05), with the CIN group showing more reduction. Analysis of the number of responders showed that in the CIN group 61.2% subjects were responders, and 63.8% in the SV group. No statistically significant differences between the treatment groups were found for any of the secondary parameters. Overall 26 subjects reported one or more adverse events during the study period: 13 subjects in each group. Five subjects discontinued prematurely due to adverse events; two in the CIN group with significant weight gain, and 3 in the SV group with significant weight gain and severe tremor. These results suggest that CIN is an effective and safe prophylactic agent even in severe migraine headache.
Keywords: Migraine prophylaxis, Cinnarizine, Sodium valproate
Full Text
The Full Text of this article is available as a PDF (207.6 KB).
Footnotes
An erratum to this article can be found at http://dx.doi.org/10.1007/s10194-008-0044-8
References
- 1.Silberstein SD, Lipton RB, Goadsby PJ. Headache in clinical practice. 2nd edn. Oxford: Martin Dunitz; 2002. [Google Scholar]
- 2.Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and duration of migraine in the United States: data from American Migraine Study II? Headache. 2001;41:646–657. doi: 10.1046/j.1526-4610.2001.041007646.x. [DOI] [PubMed] [Google Scholar]
- 3.Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, et al. Topiramate for migraine prevention: a randomized controlled trial. JAMA. 2004;291:265–273. doi: 10.1001/jama.291.8.965. [DOI] [PubMed] [Google Scholar]
- 4.Kuy PH, Lohman JJ. A quantification of the placebo response in migraine prophylaxis. Cephalalgia. 2002;22:265–270. doi: 10.1046/j.1468-2982.2002.00363.x. [DOI] [PubMed] [Google Scholar]
- 5.Goadsby PJ, Lipton RB, Ferrari MD. Migraine current understanding and treatment. N Eng J Med. 2002;346:257–270. doi: 10.1056/NEJMra010917. [DOI] [PubMed] [Google Scholar]
- 6.Silberstain SD. Practice parameters: evidence-based guidelines for migraine headache (an evidence-based review): report of the quality standard subcommittee of the American Academy of Neurology. Neurology. 2000;55:754–762. doi: 10.1212/wnl.55.6.754. [DOI] [PubMed] [Google Scholar]
- 7.Petkov GV, Fusi F, Saponara S, Gagov HS, Sgaragli GP, Boev KK. Characterization of voltage-gated calcium currents in freshly isolated smooth muscle cells from rat tail main artery. Acta Physiol Scand. 2001;173:257–265. doi: 10.1046/j.1365-201X.2001.00907.x. [DOI] [PubMed] [Google Scholar]
- 8.Arab SF, Duwel P, Jungling P, Westhofen M, Luckhoff A. Inhibition of voltage-gated calcium currents in type II vestibular hair cells by cinnarizine. Naunyn Schmiedebergs Arch Pharmacol. 2004;369:570–575. doi: 10.1007/s00210-004-0936-3. [DOI] [PubMed] [Google Scholar]
- 9.Pianese CP, Hidalgo LO, Gonzalez RH, Madrid CE, Ponce JE, Ramirez AM, et al. New approaches to the management of peripheral vertigo: efficacy and safety of two calcium antagonists in a 12-week, multinational, double-blind study. Otol Neurotol. 2002;23(3):357–363. doi: 10.1097/00129492-200205000-00023. [DOI] [PubMed] [Google Scholar]
- 10.Italian society for the study of headache (SISC) Guidelines and recommendations for the treatment of migraine. Func Neurol. 1993;8:441–446. [PubMed] [Google Scholar]
- 11.Comitato Drug Trial della SISC (a cura di FGranella e LA Pini) Linee guida e raccomandazioni per il trattamento dell’emicrania. II Edizione. Confinia Cephalalgica. 1999;8:73–78. doi: 10.1159/000026073. [DOI] [Google Scholar]
- 12.BASH Management Guidelines. Guidelines for all doctors in the diagnosis and management of migraine and tension-type headache. British Association for the study of headache. 2nd edn. approved for publication 27 March 2000. http://www.bash.org.uk/guidelines.htm
- 13.Diener HC, Kaube H, Limmroth A. A practical guide to the management and prevention of migraine. Drugs. 1998;56:811–824. doi: 10.2165/00003495-199856050-00006. [DOI] [PubMed] [Google Scholar]
- 14.Danish Neurological Society, the Danish Headache Society Guidelines for the management of headaches. Cephalalgia. 1998;18:9–22. doi: 10.1046/j.1468-2982.1998.1801009.x. [DOI] [PubMed] [Google Scholar]
- 15.Nattero G, Agostoni A, Brandi G, Cottino A, Gai V, Gastaldi L, Lisino F. Therapeutic possibilities in idiopathic headaches. Analysis of about 1,000 cases. Minerva Med. 1976;67:1999–2006. [PubMed] [Google Scholar]
- 16.Drillisch C, Girke W. Results of treatment of migraine patients with cinnarizine and flunarizine. Med Welt. 1980;31:1870–1872. [PubMed] [Google Scholar]
- 17.Rossi P, Fiermonte G, Pierelli F. Cinnarizine in migraine prophylaxis: efficacy, tolerability and predictive factors for therapeutic responsiveness. An open-label pilot trial. Funct Neurol. 2003;18:155–159. [PubMed] [Google Scholar]
- 18.Togha M, Ashrafian H, Tajik P. Open-label trial of Cinnarizine in migraine prophylaxis. Headache: J Head Face Pain. 2006;46:498–502. doi: 10.1111/j.1526-4610.2006.00381.x. [DOI] [PubMed] [Google Scholar]
- 19.Amelin AV, Skoromets AA, Gonchar MA, Tumelevich BCh, Nikitin KA. Comparative efficacy of betaserc and Cinnarizine in vertigo in patients with migraine. Zh Neurol Psikhiatr Im S S Korsakova. 2003;103:43–48. [PubMed] [Google Scholar]
- 20.The International Headache Society Committee on Clinical Trials on Migraine Guidelines for controlled trials of drugs in migraine, 1st edn. Cephalalgia. 1991;11:1–12. doi: 10.1046/j.1468-2982.1991.1101001.x. [DOI] [PubMed] [Google Scholar]
- 21.Headache Classification Committee of the International Headache Society Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia. 1988;8(Suppl 7):1–96. [PubMed] [Google Scholar]
- 22.Erdemglu AK, Ozbakir S. Valproic acid in prophylaxis of refractory migraine. Acta Neurol Scand. 2000;102:354–358. doi: 10.1034/j.1600-0404.2000.102006354.x. [DOI] [PubMed] [Google Scholar]
- 23.Mathew NT, Saper JR, Silberstain SD, Rankin L, Markley HG, Solomon S, et al. Migraine prophylaxis with divalproex. Arch Neurol. 1995;52:281–286. doi: 10.1001/archneur.1995.00540270077022. [DOI] [PubMed] [Google Scholar]
- 24.Klapper J. Divalproex sodium in migraine prophylaxis: a dose-controlled study. Cephalalgia. 1997;17:103–108. doi: 10.1046/j.1468-2982.1997.1702103.x. [DOI] [PubMed] [Google Scholar]
- 25.Mathew NT, Rapoport A, Saper J, Magnus L, Klapper J, Ramadan N, et al. Efficacy of gabapentin in migraine prophylaxis. Headache. 2001;41:119–128. doi: 10.1046/j.1526-4610.2001.111006119.x. [DOI] [PubMed] [Google Scholar]
- 26.Hering R, Kuritzky A. Sodium valproate in the prophylactic treatment of migraine: a double-blind study versus placebo. Cephalalgia. 1992;12:81–84. doi: 10.1046/j.1468-2982.1992.1202081.x. [DOI] [PubMed] [Google Scholar]
- 27.Hering R, Kuritzky A. Sodium valproate in the treatment of cluster headache: an open clinical trial. Cephalalgia. 1989;9:195–198. doi: 10.1046/j.1468-2982.1989.0903195.x. [DOI] [PubMed] [Google Scholar]
- 28.Shaygannejad V, Janghorbani M, Ghorbani A, Ashtary F, Zakizade N, Nasr V. Comparison of the effect of topiramate and sodium valproate in migraine prevention: a randomized blinded cross over study. Headache. 2006;46:642–648. doi: 10.1111/j.1526-4610.2006.00413.x. [DOI] [PubMed] [Google Scholar]
- 29.Mitsikostas DD, Polychronidis I. Valproate versus flunarizine in migraine prophylaxis: a randomized, double-open, clinical trial. Funct Neurol. 1997;12:267–276. [PubMed] [Google Scholar]
- 30.Gimenez-Rolan S, Mateo D. Cinnarizine-induced parkinsonism. Susceptibility related to aging and essential tremor. Clin Neuropharmacol. 1991;14:156–164. doi: 10.1097/00002826-199104000-00005. [DOI] [PubMed] [Google Scholar]