Efficacy and Tolerability of Flunarizine in the Prophylaxis of Migraine

Centonze, Vincenzo; Tesauro, P; Trizio, T.; Magrone, D; Vino, M; Macinagrossa, Giuseppe; Campanozzi, F; Altomare, Emanuele; Attolini, Ettore; Albano, O

doi:10.1177/03331024850050s231

Cited by 14 publications

(8 citation statements)

References 8 publications

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“…The Ônon-specificÕ calcium channel blocker flunarizine has been shown to be effective in migraine prophylaxis in several studies [90,98,[102][103][104][105][106][107][108][109][110][111]. The dose is 5-10 mg, female patients seem to benefit from lower doses than male patients [112].…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force

Evers

Áfra²,

Frese

et al. 2009

Euro J of Neurology

694

556

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Background: Migraine is one of the most frequent disabling neurological conditions with a major impact on the patientsÕ quality of life. Objectives: To give evidence-based or expert recommendations for the different drug treatment procedures in the particular migraine syndromes based on a literature search and the consensus of an expert panel. Methods: All available medical reference systems were screened for the range of clinical studies on migraine with and without aura and on migraine-like syndromes. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies (EFNS) resulting in level A, B, or C recommendations and good practice points. Recommendations: For the acute treatment of migraine attacks, oral non-steroidal antiinflammatory drug (NSAID) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAID and triptans, oral metoclopramide or domperidone is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. Status migrainosus can be treated by cortoicosteroids, although this is not universally held to be helpful, or dihydroergotamine. For the prophylaxis of migraine, betablockers (propranolol and metoprolol) flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis include amitriptyline, naproxen, petasites, and bisoprolol.

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Section: Calcium Channel Blockersmentioning

confidence: 99%

EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force

Evers

Áfra²,

Frese

et al. 2009

Euro J of Neurology

694

556

View full text Add to dashboard Cite

show abstract

“…The Ônon-specificÕ calcium channel blocker flunarizine has been shown to be effective in migraine prophylaxis in several studies [72,80,[84][85][86][87][88][89][90][91][92][93]. The dose is 5-10 mg, female patients seem to benefit from lower doses than male patients [94].…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

EFNS guideline on the drug treatment of migraine – report of an EFNS task force

Evers¹,

Áfra²,

Frese³

et al. 2006

Euro J of Neurology

134

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Migraine is one of the most frequent disabling neurological conditions with a major impact on the patientsÕ quality of life. To give evidence-based or expert recommendations for the different drug treatment procedures of the different migraine syndromes based on a literature search and an consensus in an expert panel. All available medical reference systems were screened for all kinds of clinical studies on migraine with and without aura and on migraine-like syndromes. The findings in these studies were evaluated according to the recommendations of the EFNS resulting in level A,B, or C recommendations and good practice points. For the acute treatment of migraine attacks, oral non-steroidal anti-inflammatory drugs (NSAIDs) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAIDs and triptans, oral metoclopramide or domperidon is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. A status migrainosus can probably be treated by steroids. For the prophylaxis of migraine, betablockers (propranolol and metoprolol), flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis are amitriptyline, naproxen, petasites, and bisoprolol.

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“…Prophylactic treatment for migraine is used in cases where frequency and severity of attacks warrant such an intervention. Flunarizine is a calcium overload blocker, which has been widely used in the prevention of migraine attacks and has been shown to reduce attack frequency (1–22). The evidence for an effect on attack severity is less clear.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Tolerability in Migraine Prophylaxis of Flunarizine in Reduced Doses: A Comparison with Propranolol 160 Mg Daily

Matías-Guiu²,

et al. 2002

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This was a phase-IV double-blind equivalence trial designed to assess the efficacy and tolerability of two doses of flunarizine (10 mg o.d.=FLU 10 mg and 5 mg o.d.=FLU 5 mg) in the prophylaxis of migraine, in comparison with slow-release propranolol (160 mg o.d.). A total of 808 subjects were treated in a treatment period of 16 weeks. 142 subjects discontinued the trial prematurely, mainly because of adverse events (n=58). The mean attack frequency in the double-blind period was 2.0 for the FLU 5 mg group, 1.9 for the FLU 10 mg group, and 1.9 for the propranolol group. The mean attack frequency in the last 28 days of the double-blind period was 1.8 for FLU 5 mg, 1.6 for FLU 10 mg, and 1.7 for propranolol. Both flunarizine groups were at least as effective as propranolol (P<0.001 in one-sided test). The percentage of responders (defined as subjects for whom attack frequency decreased by at least 50% compared to run-in) in the last 28 days of the double-blind period was 46% (118/259) for FLU 5 mg, 53% (141/264) for FLU 10 mg, and 48% (125/258) for propranolol. Statistical analysis showed that FLU 10 mg is at least as effective as propranolol (P<0.001) and showed a trend for noninferiority of FLU5 and propranolol (P=0.053). No statistically significant differences between the treatment groups were found for any of the secondary parameters. Overall, 190 subjects reported one or more adverse events during the run-in phase: 54 (20.5%) in the FLU 5 mg group, 76 (27.7%) in the FLU 10 mg group and 60 (22.3%) in the propranolol group. The results of this equivalence trial show that 10 mg flunarizine daily with a drug-free weekend is at least as effective as 160 mg propranolol in the prophylaxis of migraine for all evaluated parameters (one-sided equivalence tests) after 16 weeks of treatment. In addition, 5 mg flunarizine proves to be at least as effective as 160 mg propranolol when looking at the mean attack frequency for both the whole double-blind period and the last 28 days of treatment. However, in the analysis of responders, 160 mg propranolol seems to be slightly better than 5 mg flunarizine. In addition, no significant differences between the three treatments were found with regard to safety: all three treatments were generally well-tolerated and safe.

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Efficacy and Tolerability of Flunarizine in the Prophylaxis of Migraine

Cited by 14 publications

References 8 publications

EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force

EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force

EFNS guideline on the drug treatment of migraine – report of an EFNS task force

Efficacy and Tolerability in Migraine Prophylaxis of Flunarizine in Reduced Doses: A Comparison with Propranolol 160 Mg Daily

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