The Observation And Clinical Strategies Of Flunarizine Tolerance During Migraine Prevention

Objective:A familiar situation in migraine treatment was that the patients with an initial positive response to prophylactic drug therapy experienced increase in headache frequency and pain intensity later. So far, the approaches to solve migraine preventive treatment tolerance included re-using the original effective drug, the replacement of the types of drugs and drug-combination therapy, the selective behavioral therapy and environmental therapy may be effective. However, these solutions were short of reliable clinical tests for the evidence. This article was aimed to facilitate clinicians a clearer understanding of migraine prevention tolerated phenomenon. Two types of solution were used to prevent tolerance, which included replacing the types of drugs, drug combination, in order to provide clinical evidence for better treatment.Methods:Two methods were taken to ameliorate tolerance, which included switching drug, drugs combination. After a period of time for a return visit to the patient, we collected relevant information, including the patients’name, gender, age, address, contact, mode of onset, the site of headache, duration, nature and frequency of headache, associated symptoms, the predisposing factors and mitigating factors, migraine history, as well as neurology examination results, familial disease, previously drug used, the VAS score and HIT-6score before and after these measures were taken. The data were analyzed by SPSS.Result;(1)We collected27migraineaus with headache prevention tolerability from744follow-up patients in the outpatient of Department of Neurology from Shandong Provincial Hospital. The incidence of tolerance was3.6%;(2)Two-thirds of the tolerant patients were women. The patients with headache prevention tolerability were31to40years old. Those on night shift or with poor sleep showed tolerance more easily;(3)The effects of replacement of flunarizine by the five drugs that included sodium valproate, propranolol, levetiracetam, candesartan, duloxetine were not obvious;(4)The effects of combination of flunarizine with the three drugs, including sodium valproate, propranolol, levetiracetam, were also not obvious.Conclusion:(1)It is not obvious of the effect that five drugs (sodium valproate, propranolol, levetiracetam, candesartan, duloxetine) replaced flunarizine to improve tolerance of flunarizine;(2)The effect to improve tolerance of flunarizine of the combination of flunarizine and these drugs(sodium valproate, propranolol, levetiracetam),compared with using these drugs alone separately, is not obvious.