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Memantine in the Preventive Treatment of Refractory Migraine
Bigal M, Rapoport A, Sheftell F, et al.
Posted: December 2008  
Headache   2008;48:1337-1342

Objectives:   To assess the efficacy and tolerability of memantine (MEM) in the preventive treatment of refractory migraine.

Background:  Glutamate is of importance in migraine pathophysiology and may be related to progression from episodic to chronic migraine. Furthermore, individuals with chronic pain often report cognitive problems. MEM has the potential to address both issues, justifying this pilot study.

Methods:   We included subjects with refractory migraine (episodic migraine with 8-14 days of headache per month or transformed migraine, who had previously failed at least 2 trials of adequate preventive therapy). Other preventive drugs were allowed if the patient had been on a stable dose for more than 30 days. MEM dose ranged from 10 mg. to 20 mg. per day. The treatment phase lasted 3 months. The primary endpoint was number of days with headache at month 3.

Results:   Monthly headache frequency was reduced from 21.8 days to 16.1 at 3 months. The mean number of days with severe pain was reduced from 7.8 to 3.2 at 3 months. Side effects were present in 37.5% of the patients; 5.5% dropped out of the study because of poor tolerability. Most adverse events were mild.

Conclusion:   This study offers preliminary evidence for the use of MEM in the prevention of refractory migraine. Double-blind studies are now required.