CLONIDINE IN MIGRAINE PROPHYLAXIS

Abstract

SYNOPSIS Clonidine chloride, 25 ug three times per day, decreased the mean number of headache attacks per month to 2.26 compared to 3.94 before treatment and 2.98 during placebo use in 50 migraineurs. Fifty ug clonidine t.i.d. decreased mean number of attacks from 4 before treatment to 1.88 during treatment and 2.49 during placebo. Frequency of attacks decreased in 44% of patients, were unchanged in 46% of patients and increased in 10% of patients on 25 ug t.i.d., and 50 ug clonidine t.i.d. decreased attacks in 58% of patients, frequency was unchanged in 40% of patients and increased in 1%. Practolol, a beta adrenergic blocker, decreased frequency of attacks in 41% of patients, attack frequency was unchanged in 42% of patients, and increased frequency in 16% of patients receiving it 50 mg t.i.d. Mean duration of attacks decreased from 3.86 hours before treatment to 2.16 hours after clonidine in the 25 ug t.i.d. dosage and to 1.86 after clondine in the 50 ug t.i.d. dose. Attack duration was 2.37 hours after practolol therapy and 3.36 hours after placebo. The duration of attacks were decreased in 38% of patients receiving 25 ug of clonidine t.i.d., were unchanged in 60% and increased in 2%. In those patients receiving 50 ug clonidine t.i.d. duration of attacks were decreased in 52%, unchanged in 46% and increased in 2%. With practolol 50 mg t.i.d. duration of attacks were decreased in 41%, unchanged in 43% and increased in 16% of patients. Prodromal symptoms were not reduced by clonidine in the 25 or 50 ug t.i.d. dose nor with practolol. Medication was not clearly effective in improving general well-being or ability to work of patients receiving clonidine in either dose nor practolol. Practolol was associated with sedation in 21% of patients. Increased clonidine dose was associated with sedation in 21% of patients. Increased clonidine dose was associated with increased nausea and sedation. It was concluded that practolol has insufficient anti-migraine effect to justify its use as a routine prophylactic agent. Clonidine is useful in the prophylactic treatment of migraine