PROPHYLACTIC TREATMENT OF MIGRAINE WITH PROPRANOLOL

30 patients suffering from intractable, repetitive migraine took part in a double-blind single-crossover trial to compare the effect of propranolol (at 120 mg per day) with that of placebo. During propranolol treatment the frequency of migraine attacks was reduced significantly; by more than 50 per cent in 9 patients and by less than 50 per cent in a further 9. In the remainder propranolol showed no advantage over placebo. It is concluded that, as propranolol has only few and mild side effects, it is a useful drug for preventing migraine attacks. As the pathogenesis of migraine is not completely understood, the mode of action of propranolol in preventing attacks cannot be fully explained. It has been possible, however, to relate some of the effects of betareceptor antagonism to the current knowledge of the condition.     

PROPHYLACTIC TREATMENT OF MIGRAINE WITH CLONIDINE

In a double-blind crossover trial of two 12-week treatment periods with a 4-week treatment free interval, to which 21 patients were admitted, there was no statistically significant difference between clonidine 75 microgram twice daily and placebo in the total number of headache days, migraine indices, duration of attacks, number of severe attacks and consumption of acute attack treatment. However, there was a marked reduction in number of headache days, migraine indices, duration of attacks and consumption of acute attack treatment during the second treatment period compared to the first treatment period, regardless of the treatment regime. This was presumably a result of prolonged treatment and frequent attention and not an effect of the active drug. 32 patients entered the trial, but 11 dropped out. Of the 21 patients completing the trial, 16 were women; the median age was 34 years (range 17-54 years) and the median duration of headaches 12 years (range 1-40 years). Only mild side-effects were registered and no laboratory abnormalities were seen.     

OXPRENOLOL IN THE TREATMENT OF MIGRAINE

Thirty migraine patients received oxprenolol (Trasicor), which is an adrenergic beta-receptor blocking agent with weak beta-stimulating intrinsic activity. The dosage was 80 mg three times a day. The treatment was given by a double blind cross-over technique in which the effect was compared with placebo. Each compound was administered for 8 weeks with an intermediate week without medication (wash-out). Oxprenolol had no significant effects in the prevention of migraine attacks. Our study lends further support to the assumption that differences may exist between different beta-receptor blocking agents in their effectiveness in migraine prophylaxis.     

PROPANOLOL (''INDERAL'') IN THE TREATMENT OF CHILDHOOD MIGRAINE

In a double-blind crossover study of 39 children with established migraine, there was no difference between treatment with propanolol and placebo as regards frequency, severity or average duration of migraine attacks. There was some evidence that propanolol increased the average length of headaches.     

BIOFEEDBACK AND RELAXATION—RESPONSE TRAINING IN THE TREATMENT OF PEDIATRIC MIGRAINE

To assess the efficacy of electromyographic biofeedback, relaxation-response training and pain behavior management as a treatment for pediatric migraine, we studied 18 children between the ages of eight and 12 years (mean = 10 X 1) in a prospective, randomized, controlled investigation. Six patients received all three treatment procedures, six received relaxation-response training and pain behavior management, and the remaining six constituted a waiting-list control group. All patients kept a record of their headaches for the 15-week study period and then for four weeks one year later. Following four weeks of baseline, the treatment groups completed nine one-hour treatment sessions in 11 weeks. Both treatment groups experienced a significant reduction in headache symptoms and were significantly improved compared to the waiting-list control group by the end of treatment. The treatment groups did not differ from each other in any of these comparisons. The reduction in headache symptoms in the treatment groups was maintained one year after treatment ended. These results suggest that relaxation-response training, with or without biofeedback training, combined with pain behavior management, is an effective alternative treatment for pediatric migraine.     

THE PROPHYLACTIC TREATMENT OF MIGRAINE WITH AN ANTISEROTONIN PIZOTIFEN (BC 105)

The prophylactic effect of an antiserotonin Pizotifen (BC 105) in migraine has been investigated by means of a double-blind crossover trial. Pizotifen 1 mg t.i.d. and Prochlorperazine (Stemetil®) 5 mg t.i.d. were administered for two periods of eight weeks, in random order, to 40 outpatients with migraine. The investigation revealed no significant difference in the effect of the two drugs with regard to frequency of attacks, duration of attacks, number of attacks necessitating the patient's absence from work, incidence of associated symptoms, or use of supplementary drugs during the attacks. Increase in weight was a common and extremely disturbing side effect of the treatment with Pizotifen. The study has demonstrated that Pizotifen has little effect in the prevention of migraine; this is contrary to the results of the few well-controlled investigations which have hitherto been reported.     

DIAGNOSTIC CRITERIA FOR MIGRAINE AND PSYCHOGENIC HEADACHE IN CHILDREN

The headache histories obtained from 214 children were analysed by computer to see whether it was possible to identify and classify migraine, and to distinguish children with psychogenic headache. During headache attacks, most children had no or very few associated symptoms. For classification, 175 patients were divided into four homogeneous groups; the remaining 39 could not be grouped. An overlap between the different groups was found. Psychogenic headache emerged as a clearly definable syndrome, characterised by psychological problems and daily headache for a period of at least one month (10 patients). When the 214 patients were grouped according to the classification of the Headache Classification Committee of the International Headache Society, distinguishing those children with psychogenic headache was no longer possible.     

REVIEW OF NUTRITIONAL SUPPLEMENTS FOR THE TREATMENT OF BIPOLAR DEPRESSION

Many patients view psychotropics with skepticism and fear and view nutritional supplements as more consistent with their values and beliefs. The purpose of this review was to critically evaluate the evidence base for nutritional supplements in the treatment of bipolar depression (BD). A literature search for all randomized, controlled clinical trials using nutritional supplements in the treatment of BD was conducted via PubMed and Ovid MEDLINE computerized database. The studies were organized into essential nutrients/minerals, nonessential nutrients, and combinations of nutritional products. Among essential nutrients/minerals, omega‐3‐fatty acids (O3FAs) have the strongest evidence of efficacy for bipolar depression, although some studies failed to find positive effects from O3FAs. Weak evidence supports efficacy of vitamin C whereas no data support the usefulness of folic acid and choline. Among nonessential nutrients, cytidine is the least supported treatment. Studies of N‐acetylcysteine have not resolved its efficacy in treating acute depressive episodes relative to placebo. However, one study demonstrates its potential to improve depressive symptoms over time and the other, though nonsignificant, suggests it has a prophylactic effect. Studies of inositol have been mostly negative, except for 1 study. Those that were negative were underpowered but demonstrated numerically positive effects for inositol. There is no evidence that citicholine is efficacious for uncomplicated BD depression, though it may have value for comorbid substance abuse among BD patients. Finally, combination O3FA‐cytidine lacks evidence of efficacy. The findings of this review do not support the routine use of nutritional supplements in the treatment or prophylaxis of BD depression. Studies with more rigorous designs are required before definitive conclusions can be made. Despite the inadequacy of the existing data, clinicians should remain open to the value of nutritional supplements: after all, lithium is a mineral too.