Research Article

iMedPub Journals 2017

Journal of Headache & Pain Management
http://www.imedpub.com ISSN 2472-1913 Vol. 2 No. 3:14

DOI: 10.4172/2472-1913.100044

Preventive Treatment of Migraine: Which Domenico Chirchiglia,

Drugs to Choose. Own Experience Attilio Della Torre,
Carmelino Angelo Stroscio and
Angelo Lavano
Abstract Department of Neurosurgery, University
of Catanzaro, Magna Graecia, Italy
Migraine prophylaxis is a demonstrated viable therapeutic option, providing
positive results through the use of drugs, more and more safe and effective. These
drugs are anticonvulsant, antidepressant, calcium channel blockers, beta blockers,
making a notable contribution according to studies reported in the literature. But Corresponding author:
they also have side effects, usually less than their efficacy. In this study we report Domenico Chirchiglia
our series of migraineurs with and without aura, treated with prophylactic drugs.
In the study we used the drugs of first choice and we used VAS scale to assess
pain intensity, checking patients for 8 months, with good results, in some cases
excellent. Data from literature show that these new nutraceutical substances,  [email protected]
besides to those already in use, are utilized successfully, opening new therapeutic
perspectives. Do not resort to symptomatic drugs, it is very important, being rich
in adverse, potentially harmful effects, so migraine prophylaxis remains a useful MD, Professor of Department of
instrument of defense in these patients. Neurosurgery, Neurophysiopathology Unit,
University of Catanzaro, Magna Graecia,
Keywords: Migraine prophylaxis; Calcium channel blocker; Antidepressant;
Italy - Viale Europa, Germaneto 88100
Valproate; Topiramate
Catanzaro, Italy.

Received: September 26, 2016; Accepted: October 23, 2017; Published: November Tel: +3909613697410
02, 2017

Citation: Chirchiglia D, Attilio DT, Carmelino

Introduction AS, et al. Preventive Treatment of Migraine:
The prophylactic treatment of migraine is still a matter for Which Drugs to Choose. Own Experience. J
discussion, as to the choice of appropriate medication, as regards Headache Pain Manag. 2017, 2:3.
the drug to be used, taking into account the effectiveness and
adverse effects, which make the prophylaxis a tailored process
to each migraine patient [1]. A number of drugs have been
used over time, including antidepressants such as amitriptyline, with aura, 160 females and 40 males, aged 22-51 years, mean
anticonvulsant such as valproate and topiramate, calcium channel 36.5, observed at the Neurophysiopathology Unit of Catanzaro
blockers such as flunarizine, beta blockers. The results are University Hospital, in a period of about 10 years. All patients
variable, in terms of effectiveness, according to studies reported had a family history of migraine, used painkillers and/or triptans,
in the literature, demonstrating the efficacy and safety of anti- no one had practiced prophylactic therapy of migraine, with no
migraine prophylactic drugs in some subjects, less in others. In benefit for pain and reduced quality of life, referring improvement
our study, we report a case series of 200 patients with migraine, in pain only during the attack. Causes of secondary headache have
including 180 without aura and 20 with aura, 160 females and 40 been excluded by neuroimaging and ultrasound examinations for
males. We used sodium valproate, topiramate, beta blockers and vascular disorders. Prophylactic therapy was set, by administering
flunarizine, experiencing good results, in some cases excellent, the following drugs: valproate, topiramate, flunarizine, beta
with little or no adverse effects. In a high percentage of cases blockers, each for a group of 50 patients. IHS guidelines were
the effectiveness of the pharmacological prophylaxis migraine observed for pharmacologic doses and associated comorbidities.
therapy was demonstrated. It was considered greater inclusion criterion the rate of more
than 2-3 attacks per month with worsening in quality of life.
Materials and Methods
Therefore, drugs were administered according to the following
The cases cover 200 migraine patients, 180 without aura and 20
scheme: metoprolol 100 mg daily oral dose, sodium valproate 600

© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://headache.imedpub.com/ 1
 ARCHIVOS
Journal of Headache DE MEDICINA
& Pain Management 2017
ISSN
ISSN 1698-9465
2472-1913 Vol. 2 No. 3:14

mg daily oral dose, topiramate 100 mg daily oral dose, flunarizine migraine aura, 80% versus 20% [3]. Pathophysiology of migraine,
10 mg daily oral dose. In addition, each patient was subjected to at present, involves neurovascular mechanisms regarding cortical
the VAS (Visual Analogic Scale), an algometric test which allows spreading depression and activation of trigeminal-vascular
the subject to locate on a colored bar numbered from 0 to 10 pain system [4,5]. A problem relating to migraine is its chronic course,
intensity. The patients were monitored for a period of 8 months. influencing quality of life of these subjects. So, it is necessary to
The results were as follows: 25 of the 50 patients treated with find an effective therapy, even being safe, about adverse effects.
metoprolol suspended therapy, for the appearance of marked Drugs used in migraine are symptomatic, pain relievers and
bradycardia; 13 of the remaining subjects, after the first month triptans, helpful during attack phase, but not in chronic course.
of therapy, reported a slight improvement on pain (VAS9), 12 did Therefore, migraine prophylaxis is very important, including
not report any improvement. several drugs, used in other diseases, such calcium channel
blockers, antiepileptic drugs, betablockers, antidepressant drugs
After the second month of therapy, 13 to 25 reported further
and others [6]. Preventive treatment is recommended more than 2
improvement (VAS 6), while 12 slightly (VAS 9), in the following
days a week to those patients who do not tolerate medications for
months control all 25 patients reported stabilization of pain (VAS
acute attack, following the IHS criteria [7]. Migraine prophylaxis is
5), frequency attacks 1 every 2 months. At successive controls, the
effective if frequency and intensity of migraine attacks is reduced
clinical picture did not change. The administration of valproate
by at least 50%. According to data, the drugs of choice, deemed
gave the following results: an oral dose of 600 mg per day, after
useful in the preventive treatment of migraine, are now fully
a month, causing a slight improvement in pain (VAS 8), but after
entered successfully in the various protocols. On the other hand
the second month, the improvement was greater (VAS 5), until
adverse effects, sometimes mild, sometimes severe, are also
the eighth month, further improvement (VAS 4), frequency
known. Most studies recognize the validity of migraine drugs [6].
attack, 1 every 3 months. Topiramate was administered at a 100
Recently, some studies have suggested prophylaxis nutraceutical
mg daily oral dose, with the following results: already after the
substances such as endogenous lipids, with interesting results,
first month, significant improvement in pain (VAS 5), further after
opening new therapeutic perspectives [8,9]. Our study highlights
the second month (VAS 4). At the eighth month, VAS 2, frequency
the efficacy and safety of prophylactic drugs used. The results
attack, 1 every 4-5 months. Flunarizine at a dose of 10 mg daily
obtained from the tested drugs, firstly flunarizine, proved to be
was administered, showing the following results: after the first
the most effective.
month, significant improvement in pain (VAS 4), further after
second month (VAS 2), subsequently progressive improvement,
at eighth month VAS 0, absence of attacks. None of the used
Conclusion
drugs caused adverse effects, except some slight sedation in the Migraine prophylaxis is a key measure to prevent migraine
early days of treatment by topiramate and valproate. headaches, showing that prophylactic drugs are effective and
safe. Our study deals with the literature data on the effectiveness
Discussion of the treatment of the migraine. Calcium channel blockers, beta
Primary migraine headaches usually affect one half of the head, blockers, topiramate, valproate are all drugs considered in the
presenting pulsatile pain, nausea, vomiting, phonophobia, first choice. In our study we have found the effectiveness and
photophobia, lasting 24-72 hours. 10-15% people have a safety of these drugs, noting that beta blockers are effective but
progressive course [2]. Migraine headache is divided into migraine with significant adverse effects in approximately 50% of treated
without aura, previously described as common migraine, and patients, good results from valproate and topiramate, excellent
migraine with aura, mostly characterized by visual disturbance, from flunarizine. At present, migraine prophylaxis remains the
before onset of pain. Migraine without aura is more frequent than type of treatment to follow, able to give relief to these patients.

2 This article is available in: http://headache.imedpub.com/

 ARCHIVOS
Journal of Headache DE MEDICINA
& Pain Management 2017
ISSN
ISSN 1698-9465
2472-1913 Vol. 2 No. 3:14

References Neurovascular Coupling in Migraine? BioMed Research International

2015: 574186.
1 Davoine E, Kleinschmidt A (2016) Migraine: from generic
6 Jackson JL, Cogbill E, Santana-Davila R (2015) A Comparative
recommendations to practical taking in charge. Rev Med Suisse 12: Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine
1214-1219. Headache. PLoS ONE 10: e0130733.
2 Buture A, Gooriah R, Nimeri R, Ahmed F (2016) Current 7 Headache Classification Subcommittee of the International Headache
Understanding on Pain Mechanism in Migraine and Cluster Society (2013) The international classification of headache disorders.
Headache. Anesthesiology and Pain Medicine 6: e35190. 3rd edn. Cephalalgia 33: 629-808.
3 Winter AC, Berger K, Buring JE, Kurth T (2012) Associations 8 Chirchiglia D, Della Torre A, Stroscio CA, et al (2016) Administration
of socioeconomic status with migraine and non-migraine of palmitoylethanolamide in combination with topiramate in the
headache. Cephalalgia 32: 159-170. preventive treatment of nummular headache. International Medical
Case Reports Journal 9: 193-195.
4 Dalkara T, Nozari A, Moskowitz MA (2010) Migraine aura
pathophysiology: the role of blood vessels and microembolisation. 9 Re G, Barbero R, Miolo A, Di Marzo V (2007) Palmitoylethanolamide,
Lancet neurology 9: 309-317. endocannabinoids and related cannabimimetic compounds in
protection against tissue inflammation and pain: potential use in
5 Fabjan A, Zaletel M, Žvan B (2015) Is There a Persistent Dysfunction of companion animals. Vet J 173: 21-30.

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