Safety and efficacy of flunarizine in childhood migraine: 11 years’ experience, with emphasis on its effect in hemiplegic migraine

Abstract

AIM The aim of this study was to report a single-centre experience of flunarizine in childhood migraine with focus on safety and efficacy.METHOD We conducted a retrospective observational audit of 72 individuals (40 male, 32 female; mean age 13y; age range 1y 6mo-17y) at a tertiary paediatric neurology unit between 1998 and 2009. Children were included if they had a diagnosis of migraine and at least one follow-up assessment and a minimum of 3 months' treatment with flunarizine. RESULTSOf 102 individuals identified, 30 were excluded for the following reasons: no outcome data (n=13), non-migraineurs (n=9), missing records (n=4), or inadequate treatment duration (n=4). Of the final cohort (72 individuals), 44 had migraine without aura, 15 had migraine with aura or childhood migraine equivalents, eight had sporadic hemiplegic migraine, and five had familial hemiplegic migraine. The median age was 13 years (1y 6mo-17y) and median duration of migraine was 48 months. Starting dose was 5mg. Other doses used were 2.5mg (three individuals), 7.5mg (one individual), and 10mg (six individuals). Treatment duration was 12 months. Successful prophylaxis, defined as at least a 50% reduction in attack frequency, was observed in 57% (41 ⁄ 72). Response rate was higher among those with hemiplegic migraines (85%) than in those who did not have hemiplegic migraines (51%). Side effects were noted in 15 (21%) individuals (depression, n=6; weight gain ⁄ increased appetite, n=5; tiredness ⁄ sedation, n=2; and worsening headache, n=2), and led to discontinuation of treatment in 13.

Flunarizine in migraine‐related headache prevention: results from 200 patients treated in the UK

“…The tolerability and side effect data are comparable with previous studies using flunarizine, in that the most common side effects reported are fatigue, weight gain and mood change []. We did not find in this patient cohort a significant association between those reporting low mood on the drug with those who had a prior history of depression.…”

“…This study does suggest increased efficacy in the aura group compared with the non‐aura group. Additionally, flunarizine does seem to have a particular effectiveness in hemiplegic migraine in the paediatric population . In the majority of cases, previous migraine preventive medication had been tried before flunarizine was introduced in this patient group.…”

Management of children and young people with headache

“…Some weaker evidence is also available for valproate,7 flunarizine,17 18 amitriptyline7 and riboflavin 7. Unfortunately, there is no good evidence for pizotifen's efficacy7 despite being a ‘licensed’ and popular treatment in the UK and it certainly seems to work well for some children and young people, in the authors' experience.…”

Prevention for Pediatric and Adolescent Migraine

“…Many studies in adults and children have noted a high incidence of side effects with flunarizine. Incidence of significant side effects up to 21% in children have been noted, the most common of which were sedation, weight gain, and depression …”