The Role of Calcium Channel Blocking Agents in the Prevention of Migraine

Abstract

Vascular headache pathophysiology and manifestations are reviewed along with the role that calcium channel blocking agents play in prevention of these vascular headaches. Of the calcium channel blockers presently marketed in the U.S., verapamil has been the most widely studied. Verapamil has been shown to produce a significant improvement in frequency and duration of migraine as compared with placebo. Calcium channel blocking agents that have been studied and used outside of the U.S. are flunarizine and nimodipine, both of which provide significant improvement in measures of migraine severity, duration, frequency, and other pain and severity indices. There have been no controlled trials comparing these agents with each other as with beta-blocking agents and other prophylactic agents presently marketed in the U.S. Calcium channel blocking agents may become the drugs of first choice in migraine prophylaxis due to their effectiveness and mild side effect profile.

Diagnosis and Treatment of Migraine

“…Nondihydropyridine calcium channel blockers (ie, verapamil) and selective serotonin reuptake inhibitors have also been tested in clinical trials, with equivocal lackluster results that mirror their low efficacy in clinical practice. 35 Valproic acid was the first anticonvulsant to be approved for migraine prophylaxis. 36,37 Since then, several new antiepileptic medications have been evaluated for the prophylaxis of migraine, including gabapentin and topiramate, and have shown preliminary evidence of efficacy.…”