Migraine attacks

Abstract

Twenty-six patients with migraine attacks were treated for 3 to 16 months with flufenamic acid (125 mg four to six times per attack), an inhibitor of prostaglandin synthesis and action. In 25 patients the drug afforded symptomatic relief in 195 of 200 treated attacks. Side effects observed were mild dyspepsia (eight patients) and severe upper gastrointestinal symptoms (two patients). None of the eight patients treated with placebo reported any relief (20 attacks). The "common" antimigraine drugs afforded symptomatic relief in 12 of the patients, partial relief in seven, and no relief in seven. Treatment with flufenamic acid was based on the hypothesis that prostaglandins are involved in migraine attack and that the drug relieves migraine by inhibition of the vasoactivity of prostaglandins.

Ophthalmoplegic Migraine: Amelioration by Flufenamic acid, a Prostaglandin inhibitor

“…A clinical trial with fenamates was successful in primary dysmenorrhea in which PGF2" plays an important role [Schwartz et al} 1974]. In a previous study [Vardi et al, 1976] we found that fenamates were effective in alle viating migrainous attacks.…”

“…However, it should be mentioned that in another series published by us [Vardi et al, 1976] 2 patients abandoned treatment because of severe nausea and vomits.…”

“…This palsy lasted from 1 week till 1 month. The same group of patients was treated during a 2nd year with flufenamic acid (Flunalgan, Rafa Labo ratories Ltd., Jerusalem/Arlef, Parke Davis, Milano) at a dosage level of 250 mg (2 tab lets of 125 mg) every 2 h, to a total dos age not exceeding 8 tablets (1,000 mg) taken only during the attacks [Vardi et al, 1976]. During the trial the patients were seen once in a month.…”

The Relationship of Pathogenetic Mechanisms to Treatment in Patients with Pain

“…This is followed within 20-30 min by intra-and extracranial vasodi latation, related initially to a serotonin-in duced release from lung tissue of circulating prostaglandins, and later to low circulating levels of serotonin itself. Raskin [1982] is not convinced of the importance of prostaglan dins in the pathogenesis of this disorder, pointing to conflicting evidence in the litera ture [Vardi et al, 1976;Lindegaard et al" 1980] on the effect of prostaglandin-antago nist drugs in the abortion of migrainous at tacks. Nor is he impressed by the hypothesis of an exclusive vascular mechanism.…”

L‐Dopa Effect on Prolactin Plasma Levels in Complicated and Common Migrainous Patients

“…10 Estrogen withdrawal, which is presumably associated with falling prolactin levels, may precipitate migraine. 16,17 If prostaglandin F 2a is associated with a complicated migrainous attack, one should expect elevated prolactin plasma levels during a migrainous attack. 13 On the other hand the potent prolactin stimulating drug metoclopramide, seems to be effective in the treatment of migraine, which would rule out any simple association between high prolactin plasma levels and migraine.…”