Cinnarizine in refractory migraine prophylaxis: efficacy and tolerability. A comparison with sodium valproate

Togha, Mansoureh; Jirde, Masoud Rahmat; Nilavari, Kiafar; Ashrafian, Hosein; Razeghi, Soodeh; Kohan, Leila

doi:10.1007/s10194-008-0013-2

Cited by 19 publications

(12 citation statements)

References 21 publications

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“…These receptors mediate or prevent degranulation of MCs in certain conditions in related venues (Rosa and Fantozzi, 2013; Alstadhaug, 2014). Cromolyn and antihistaminics were used for migraine prophylaxis (Rossi et al, 2003). But only a small proportion of migraineurs have benefited from them, possibly due to the variety of mast cell responses and mast cell mediator contents.…”

Section: Mast Cellsmentioning

confidence: 99%

Shared Fate of Meningeal Mast Cells and Sensory Neurons in Migraine

Irmak

Kılınç

Töre

2019

Front. Cell. Neurosci.

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Migraine is a primary headache disorder which has complex neurogenic pathophysiological mechanisms still requiring full elucidation. The sensory nerves and meningeal mast cell couplings in the migraine target tissue are very effective interfaces between the central nervous system and the immune system. These couplings fall into three categories: intimacy, cross-talk and a shared fate. Acting as the immediate call-center of the neuroimmune system, mast cells play fundamental roles in migraine pathophysiology. Considerable evidence shows that neuroinflammation in the meninges is the key element resulting in the sensitization of trigeminal nociceptors. The successive events such as neuropeptide release, vasodilation, plasma protein extravasation, and mast cell degranulation that form the basic characteristics of the inflammation are believed to occur in this persistent pain state. In this regard, mast cells and sensory neurons represent both the target and source of the neuropeptides that play autocrine, paracrine, and neuro-endocrine roles during this inflammatory process. This review intends to contribute to a better understanding of the meningeal mast cell and sensory neuron bi-directional interactions from molecular, cellular, functional points of view. Considering the fact that mast cells play a sine qua non role in expanding the opportunities for targeted new migraine therapies, it is of crucial importance to explore these multi-faceted interactions.

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Section: Mast Cellsmentioning

confidence: 99%

Shared Fate of Meningeal Mast Cells and Sensory Neurons in Migraine

Irmak

Kılınç

Töre

2019

Front. Cell. Neurosci.

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“…Cinnarizine (CIN) is a well-tolerated L-type calcium channel blocker which has early onset effects on migraine prophylaxis (Togha et al 2006; Mansoureh et al 2008). While, CIN directly inhibits vestibular hair cells stimulation (Arab et al 2004) and also has antihistaminic actions (Pianese et al 2002), it seems to be a good choice in treatment of migraine with vertigo.…”

Section: Introductionmentioning

confidence: 99%

Cinnarizine for the prophylaxis of migraine associated vertigo: a retrospective study

et al. 2014

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ObjectiveTo assess the efficacy and safety of cinnarizine for the prophylaxis of migraine associated vertigo in the vestibular migraine and migraine with brainstem aura.BackgroundVestibular migraine and migraine with brainstem aura are two principal clinical syndromes that frequently are associated with vertigo. Since cinnarizine is a well-tolerated calcium channel blocker which has acceptable effect on both vertigo and migraine headache, we carried out this study to evaluate the efficacy and safety of this medication in vestibular migraine and also migraine with brainstem aura associated with vertigo.MethodsThis was a retrospective, single-center, open-label, investigation of the effects of cinnarizine on vestibular migraine and migraine with associated with vertigo. We assessed the change in monthly frequency of vertigo and also frequency, duration and intensity of migraine attacks after one, two and three months of cinnarizine administration.ResultsThe mean frequency of vertigo and also the mean frequency, duration and intensity of migraine headaches per month were reduced significantly after three months of cinnarizine therapy (all p < 0.001).ConclusionThis study suggests that cinnarizine is safe and effective in reducing both headache and vertigo aspects of “migraine plus vertigo” among the patients who suffer from either vestibular migraine or migraine with brainstem aura associated with vertigo.

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“…For safety and efficacy analyses, we included all participants who received at least one dose of the assigned drug. Missing data were handled by the multiple imputation method using the SPSS V. 25 . Five datasets were imputed and pooled data were reported for primary outcome analyses.…”

Section: Discussionmentioning

confidence: 99%

Cinnarizine and sodium valproate as the preventive agents of pediatric migraine: A randomized double-blind placebo-controlled trial

et al. 2019

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Background Few migraine preventive agents have been assessed in a pediatric population. We evaluated the safety and efficacy of cinnarizine and sodium valproate for migraine prophylaxis in children and adolescents. Methods We carried out a randomized double-blind placebo-controlled trial in the Children’s Medical Center and Sina hospital, Tehran, Iran. Eligible participants were randomly assigned in 1:1:1 ratio via interactive web response system to receive either cinnarizine, sodium valproate, or placebo. The primary endpoints were the mean change in frequency and intensity of migraine attacks from baseline to the last 4 weeks of trial. The secondary endpoint was the efficacy of each drug in the prevention of migraine. The drug was considered effective if it decreased migraine frequency by more than 50% in the double-blind phase compared with the baseline. Safety endpoint was adverse effects that were reported by children or their parents. Results A total of 158 children participated. The frequency of migraine attacks significantly reduced compared to baseline in cinnarizine (difference: −8.0; 95% confidence interval (CI): −9.3 to −6.6), sodium valproate (difference: −8.3; 95% confidence interval: −9.3 to −7.2), and placebo (difference: −4.4; 95% confidence interval: −5.4 to −3.4) arms. The decrease was statistically greater in cinnarizine (difference: −3.6; 95% confidence interval: −5.5 to −1.6) and sodium valproate (difference: −3.9; 95% confidence interval: −5.8 to −1.9) arms, compared to placebo group. Children in all groups had significant reduction in intensity of episodes compared to baseline (cinnarizine: −4.6; 95% confidence interval: −5.2 to −4.0; sodium valproate: −4.0; 95% confidence interval: −4.8 to −3.3; placebo: −2.6; 95% confidence interval: −3.4 to −1.8). The decrease was statistically greater in cinnarizine (difference: −2.0; 95% confidence interval: −3.2 to −0.8) and sodium valproate (difference: −1.5; 95% confidence interval: −2.7 to −0.3) arms, compared to the placebo group. Seventy-one percent of individuals in the cinnarizine group, 66% of cases in the sodium valproate group, and 42% of people in the placebo arm reported more than 50% reduction in episodes at the end of the trial. The odds ratio for >50% responder rate was 3.5 (98.3% confidence interval: 1.3 to 9.3) for cinnarizine versus placebo and 2.7 (98.3% confidence interval: 1.0 to 6.9) for sodium valproate versus placebo. Nine individuals reported adverse effects (three in cinnarizine, five in sodium valproate, and one in the placebo group) and one case in the sodium valproate group discontinued the therapy due to severe sedation. Conclusion Cinnarizine and sodium valproate could be useful in migraine prophylaxis in children and adolescents. Trial registration: IRCT201206306907N4.

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Cinnarizine in refractory migraine prophylaxis: efficacy and tolerability. A comparison with sodium valproate

Cited by 19 publications

References 21 publications

Shared Fate of Meningeal Mast Cells and Sensory Neurons in Migraine

Shared Fate of Meningeal Mast Cells and Sensory Neurons in Migraine

Cinnarizine for the prophylaxis of migraine associated vertigo: a retrospective study

Cinnarizine and sodium valproate as the preventive agents of pediatric migraine: A randomized double-blind placebo-controlled trial

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