Familial Hemiplegic Migraine: A New Case

SYNOPSIS
The definition of familial hemiplegic migraine is still unsettled. We report the case of a young man who has had hemiplegic migraine attacks for ten years. CT of the brain was abnormal with a low density in the temporal lobe, suggesting infarction and probably having no relation to the attacks. There was a clear family history of hemiplegic migraine, possibly with the same type of attack. Ergotamine tartrate seemed to be effective in preventing headache. This case challenges the current clinical definition of familial hemiplegic migraine, in that while the attack pattern was hereditary, the hemiplegia occurred as an aura rather than accompanying and outlasting the headache.     

Flunarizine in Migraine: A Minireview

Flunarizine is a non-selective calcium antagonist. It distributes preferentially in the adipose tissue and passes the blood brain barrier. Numerous controlled clinical studies have established that flunarizine is efficacious in migraine prophylaxis, including double-blind studies in which the drug was compared with placebo or other antimigraine drugs. To avoid side effects a special schedule or administration is necessary. Flunarizine has no myogenic effect on smooth muscle cells of the vessles. It is said to be the only calcium antagonist able to protect brain cells against hypoxic damage. In addition, the considerable body of information which shows flunarizine capable of directly influencing the central nervous system, suggests that the drug's anti-migraine action may depend on its ability to influence central phenomena.     

Familial Hemiplegic Migraine and Recurrent Episodes of Psychosis: A Case Report

Familial hemiplegic migraine (FHM) is a rare autosomal dominant form of migraine with motor aura. We present a case report of a father and son with very similar attacks of hemiplegic migraine and recurrent episodes of accompanying psychoses. Previously, such episodes led to hospitalization and extended clinical examinations, which further worsened the psychoses. Since the episodes were recognized as related to the hemiplegic migraine, a treatment strategy combining sleep and sedation was initiated and progression onto psychosis was almost completely avoided in both father and son. Genetic analyses found no causal gene mutation in the three known FHM genes, suggesting that the phenotype is caused by a yet unidentified mutation.     

Platelet Activation and Migraine: A Study with Flunarizine

SYNOPSIS
Although in common and classic migraine there is platelet activation both during painful attack and headache-free periods, the role of platelets in migraine pathogenesis is not yet understood. Therefore, in order to investigate the relationship between platelets and migraine pathogenesis, β-thromboglobulin (β-TG) and platelet factor four (PF₄), both platelet-specific alpha granule proteins, were assayed in a group of patients with classic and complicated migraine before and after administration of an anti-migraine drug, flunarizine, at a dose of 10 mg/daily. Blood samples for β-TG and PF₄ assay were collected for ten days in which the patients were headache-free. β-TG and PF₄ plasma levels were elevated in all patients in comparison with control subjects. The patients with complicated migraine showed the highest plasma values. During flunarizine treatment β-TG and PF₄ levels persisted elevated in all patients, although a slight decrease of β-TG plasma levels was observed. This data confirmed, as our previous works, that classic migraine is characterized by platelet activation "in vivo," but that this may not be strictly related to migraine pathogenesis.     

Hemiplegic Migraine in Pregnancy

SYNOPSIS
Hemiplegic migraine during pregnancy is a ram occurrence, and recovery is usually spontaneous and complete. The presence of motor and sensory deficits with migraine should prompt the obstetrician to investigate for more serious neurological conditions.
The literature contains few case reports of hemiplegic migraine during pregnancy. This paper discusses two case histories.     

Hemiplegic Migraine With CSF Abnormalities

A 30-year-old woman with hemiplegic migraine and an elevated CSF protein level with considerable pleocytosis is described. Fourteen other cases of hemiplegic migraine with cerebrospinal fluid abnormalities reported in the literature are reviewed.     

Delayed Onset Dystonia Following Hemiplegic Migraine

SYNOPSIS
A 22-year-old woman developed complete left hemiplegia and sensory loss during an attack of migraine. She recovered almost totally but two months later incoordination and twisting of the left limb was noticeable. Examination showed tremor of the left arm and dystonia of the hand and foot secondary to a small infarction of the right posterolateral thalamic nuclei. Late onset dystonia may be another sequela of complicated migraine.     

Sporadic Hemiplegic Migraine With Permanent Neurological Deficits

By definition, the neurologic impairments of hemiplegic migraine are reversible. However, a few cases of permanent neurologic deficits associated with hemiplegic migraine have been reported. Herein, we present the case of a patient with permanent impairments because of hemiplegic migraine despite normalization of associated brain magnetic resonance imaging abnormalities. Cases like these suggest the need to consider aggressive prophylactic therapy for patients with recurrent hemiplegic migraine attacks.     

Low Dose Flunarizine in the Prophylaxis of Migraine

In a period of one year (1990) we selected 40 patients suffering from migraine. For an open randomized study there were 2 groups of patients: the first were treated with 10mg of flunarizine per day and the second with 3 mg per day. The patients were treated for 4 months consecutively. There were 11 drop outs (27.5%): nine for poor compliance and 2 due to side effects. The efficacy of flunarizine in the prophylaxis of migraine was essentially identical in the two dosage groups while the incidence of side effects was considerably reduced in the patients treated with the lower dose.     

Flunarizine and Propranolol in the Treatment of Migraine

The clinical efficacy of flunarizine and of propranolol for the prevention of migraine attacks was assessed in a multicenter double-blind study lasting four months which was preceded by a single-blind placebo period of one month. For both drugs, more than half of the patients judged the effect to be good or very good. When considering the patients' daily logs, both drugs produced a significant reduction of the number of attacks. Propranolol furthermore significantly reduced the severity of attacks and the number of analgesics used during the attacks. In both groups no severe side effects were observed.     

Unusual Angiographic Appearance During Attack of Hemiplegic Migraine

SYNOPSIS
Transfemoral carotid angiography was performed in a 23-year-old man twelve hours after the abrupt onset of hemiplegic migraine. An unusual appearance of the internal carotid artery contralateral to the hemiplegia was noted. Possibly this appearance represented spasm.     

Nimodipine versus Flunarizine in Common Migraine: A Controlled Pilot Trial

SYNOPSIS
The effects of Nimodipine and Flunarizine, both calcium-antagonist drugs, in the prevention of common migraine were investigated in a double-blind randomized parallel study. Five patients of the 30 included in the study dropped out because of adverse reactions. Two were treated with Nimodipine and three with Flunarizine. Our results suggest a similar efficacy for both drugs, although Nimodipine seems to have a shorter latency of effect. Nimodipine is a useful new agent for common migraine prevention.     

Flunarizine in Migraine Prophylaxis: An Indian Trial

Flunarizine, a calcium channel blocker is considered useful in migraine prophylaxis. We report the first Indian trial with this drug. Fifteen patients with migraine were studied in a 6 months double-blind, placebo-controlled crossover trial. Flunarizine was superior to placebo in reducing the severity and duration of the individual attacks though there was no statistically significant effect on frequency of migraine attacks. The side effects most frequently caused by flunarizine were weight gain and daytime sleepiness.     

Flunarizine versus Pizotifen: A Double-Blind Study in the Prophylaxis of Migraine

SYNOPSISThe calcium entry blocker flunarizine was compared with an antiserotonin agent, pizotifen, in the prophylaxis ofmigraine. Thirty-five patients were treated under double-blind conditions for four months. The number of migraineattacks gradually declined in both groups with an eventual mean reduction of 65% and 45% in the flunarizine andpizotifen groups respectively. The efficacy of the former drug developed somewhat faster but no statisticallysignificant differences between the groups were found. Weight gain was the main side effect in both groups. Otherside effects were rare.It is concluded that flunarizine is a useful alternative for the prophylactic treatment of migraine.     

Mild Traumatic Brain Injury in a High School Football Player With Familial Hemiplegic Migraine: A Case Report

Mild traumatic brain injury is a major concern in young athletes, with an estimated 1.6-3.8 million reported concussions in the United States annually. Familial hemiplegic migraine is a rare autosomal-dominant condition characterized by sporadic episodes of transient unilateral motor weakness that may begin at any age. We present a case of a 17-year-old boy with a history of familial hemiplegic migraine who suffered prolonged symptoms after a mild traumatic brain injury during sports participation.

A Double-blind Placebo-controlled Prophylactic Study of Flunarizine (Sibelium®) in Migraine

SYNOPSIS
The potential prophylactic value of a daily dose of 10 mg flunarizine, a calcium antagonist with anti-vasospastic properties was studied in a 3-month double-blind placebo-controlled trial in 58 migraineurs. With an almost perfect mutual correlation, both the patients' overall appreciation of the treatment and the reduction of migraine attacks proved flunarizine to be effective (p<0.001). Half of the flunarizine-patients considered the treatment certainly beneficial in contrast to none of the placebo-patients. In 21 of the 29 flunarizine-patients the attack rate was lower than expected in 20 of the 29 controls it was not. Younger patients appeared to respond better to the treatment. Flunarizine displayed a gradually increasing effect; during the third month 83% of the treated patients were completely attack-free. The drug did not appear to influence the severity and duration of attacks, however. Treatment was very well tolerated. Flunarizine, therefore, appears to be a very suitable agent for migraine prophylaxis but it should be given for more than two months in order to obtain full effectiveness with this dosage.     

Sublingual Administration of Flunarizine for Acute Migraine: Will Flunarizine Take the Place of Ergotamine?

SYNOPSIS
Clinical effectiveness of 10 mg sublingual flunarizine during 89 headache attacks was observed in 68 chronic headache patients. The study population consisted of 36 patients with migraine, 12 with combined headache, 11 with muscle contraction headache (MCH) and nine with cluster headache. Improved cases, defined as cases showing more than moderate improvement, were 75.0% in the migraine group, 50.0% in the combined headache group, 18.2% in the MCH group and 33.3% in the cluster headache group. The migraine group showed a significantly higher percentage of improved cases than did the MCH group (p<0.002). The group in which subjects received flunarizine within 10 min. from the beginning of headache, showed significantly better improvement than did the group in which subjects were treated after 10 min. (p<0.01). No remarkable side effects were observed except for transient numbness of the tongue and a feeling of sleepiness. Four typical case histories utilizing flunarizine administration, and a case showing recovery from angiospasm after sublingual flunarizine administration during an angiographic examination, are reported. A possible favorable role of flunarizine during migraine attacks is discussed. Double blind studies based on the present observations are necessary.     

Flunarizine Plasma Concentrations and Side Effects in Migraine Patients

Flunarizine plasma concentrations and side effects were evaluated in migraine patients during a 3 month course of prophylactic treatment. Plasma concentrations did not correlate with daily dose (in mg/kg). Mean flunarizine levels were higher in patients showing sleepiness or sedation. Weight gain was independent of plasma concentrations. Future clinical trials of flunarizine should be supported by drug monitoring in order to clarify the relationship between plasma levels and drug effects.