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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 53, Num. 2, 2005, pp. 243-243
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Neurology India, Vol. 53, No. 2, April-June, 2005, pp. 243
Letter To Editor
Preventive therapy of migraine
Kumar Sudhir
Department of Neurological Sciences, Apollo Hospitals, Hyderabad
Correspondence Address: Department of Neurological Sciences, Apollo
Hospitals, Hyderabad, drsudhirkumar@yahoo.com
Date of Acceptance: 10-Apr-2005
Code Number: ni05080
Related article: ni05081
Sir,
I read with interest the recent report of acute myopia induced by topiramate used for migraine prophylaxis.[1] I would like to make certain observations.
Firstly, Bhattacharyya et al used two medications (flunarizine and topiramate) as the initial preventive treatment of migraine. However, the guidelines recommend usage of a single drug. The drug should be considered a failure only after an adequate trial (2-3 months) has been given.[2] After the failure of the first drug, one has the option of using another drug or a two-drug combination. Also, Bhattacharyya et al have used two second-line agents for migraine prevention at the onset. However, guidelines recommend using a first-line agent initially, which include propranolol, divalproex sodium, sodium valproate and amitryptiline among others.[2],[3] Considering the fact that adverse effects are common with most of the drugs used for migraine prevention, one should be cautious in starting two second-line drugs as the first step.
Secondly, the choice of agent should also be individualized depending on the patient profile. Bhattacharyya et al started flunarizine in an obese patient (on sibutramine for the same). Weight gain as a side effect of flunarizine is well known.[4]
REFERENCES
| 1. | Bhattacharyya KB, Basu S. Acute myopia induced by topiramate: Report of a case and review of the literature. Neurol India 2005;53:108-109. Back to cited text no. 1 |
| 2. | Snow V, Weiss K, Wall EM, Mottur-Pilson C; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med 2002;137:840-9. Back to cited text no. 2 |
| 3. | Geraud G, Lanteri-Minet M, Lucas C, Valade D; French Society for the Study of Migraine Headache (SFEMC). French guidelines for the diagnosis and management of migraine in adults and children. Clin Ther 2004;26:1305-18. Back to cited text no. 3 |
| 4. | Thomas M, Behari M, Ahuja GK. Flunarizine in migraine prophylaxis: an Indian trial. Headache 1991;31:613-5. Back to cited text no. 4 |
Copyright 2005 - Neurology India
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