From the Guidelines
Flunarizine is the most effective calcium channel blocker for migraine prophylaxis, with a recommended dose of 10 mg/d. This is based on the evidence from the study published in the Annals of Internal Medicine in 2002 1, which suggests that flunarizine has proven efficacy in the prevention of migraine. The study notes that flunarizine is commonly used in countries where it is available and has been shown to be effective in reducing the frequency of migraine attacks.
Some key points to consider when using flunarizine for migraine prophylaxis include:
- The recommended dose is 10 mg/d, which has been shown to be effective in preventing migraine attacks 1
- Common side effects include sedation, weight gain, and abdominal pain, as well as depression and extrapyramidal symptoms, particularly in elderly persons 1
- Flunarizine should be used alongside acute treatments rather than replacing them, and patients should be advised that prophylactic benefits typically develop gradually over weeks
- Regular follow-up is important to assess effectiveness and adjust dosing as needed
Other calcium channel blockers, such as verapamil, nifedipine, and nimodipine, have limited evidence to support their use in migraine prophylaxis, and are not recommended as first-line treatments 1.
From the Research
Calcium Channel Blockers for Migraine Prophylaxis
- The use of calcium channel blockers for migraine prophylaxis has been studied in several trials 2.
- Flunarizine, a calcium channel blocker, has been shown to be effective in reducing the incidence of migraine attacks, although its use is limited due to potential side effects such as weight gain, extrapyramidal symptoms, and depressive symptoms 2.
- Other calcium channel blockers, such as verapamil, diltiazem, and nifedipine, have not been proven to be effective in migraine prophylaxis, with studies showing inconsistent results 2.
- Nimodipine, another calcium channel blocker, has also failed to demonstrate significant effectiveness in migraine prophylaxis 2.
Comparison with Other Migraine Prophylaxis Treatments
- Beta-blockers, such as propranolol, are considered first-line treatments for migraine prophylaxis, with flunarizine being considered a second-line option due to its side effects 3, 4.
- Topiramate and valproate are also commonly used for migraine prophylaxis, with topiramate showing superior efficacy in reducing migraine attack severity and frequency compared to valproate in some studies 5, 6.
- Flunarizine has been compared to topiramate in some studies, with topiramate showing superior efficacy in reducing vertigo intensity, duration, and frequency in patients with vestibular migraine 6.
Efficacy and Safety of Calcium Channel Blockers
- The efficacy of calcium channel blockers in migraine prophylaxis is thought to be related to their ability to modulate monoamine mechanisms, rather than their effects on calcium channels 2.
- The safety of calcium channel blockers in migraine prophylaxis is generally considered to be good, although side effects such as weight gain, extrapyramidal symptoms, and depressive symptoms can occur 2.
- Further studies are needed to fully understand the efficacy and safety of calcium channel blockers in migraine prophylaxis, as well as their potential role in combination therapy with other treatments 3, 4.