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Efficacy of Stimulants in Chronic Migraineurs
Lawrence D. Robbins, M.D., Assistant Professor of Neurology,
Rush Medical College
Posted: May 2009
To be presented at the October 2009 meeting of the American Academy of Pain Management
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Background: Several previous studies indicated that stimulants may have utility for chronic migraine, in addition to being beneficial for certain comorbidities found in migraineurs, including ADHD, depression and fatigue. Unlike other preventives, stimulants may also aid in weight loss.
Objective: To evaluate the use of stimulants for chronic migraine.
Methods: 73 CM patients (57 female, 16 male, age range 16-78) were evaluated. The patients were prescribed stimulants (amphetamine/dextroamphetamine, dextroamphetamine, methylphenidate) during a six-year period 2002-2007. The patients were primarily treated with stimulants for the following comorbidities (some had more than one): ADHD (n=28), unipolar depression (n=28), fatigue/sleepiness (n=17), bipolar depression (n=14), narcolepsy (n=3). Chart reviews and pt. interviews were done by the treating neurologist. The patients were felt to be good candidates for stimulant medication. Headache logs were evaluated, with severity measured on a 10 point VAS.
Results: N=73. EFFICACY: Positive headache responders:1) patients remained on the medication for at least 9 months and 2) had a 30% or more improvement in headache frequency and/or severity when measured against a 3 month baseline. 55/73 (75%) pts. continued on the stimulant for at least 9 months. Of these 55, 26 pts. had a positive headache efficacy (34% of the original 73). EFFICACY IN RELATION TO COMORBIDITY: The positive efficacy of each comorbidity is: ADHD 7/28 (25%), Unipolar depression, 8/28 (29%), Fatigue/sleepiness, 6/17 (35%), Bipolar depression, 3/14 (21%), Narcolepsy, n=3, 2 pts. positive.
Adverse events: 21/73 (29%) had at least one AE: Anxiety: 9, Increased H/A:9, Insomnia:7, Nausea:6, Tachycardia:4, Depression:4, HTN:2. ABUSE OR ADDICTION: 2 pts. abused the stimulants.
Conclusion: 3 chronic migraine patients were prescribed stimulants for various comorbidities. 55 of the original 73 remained on the medication for at least 9 months, with 34% of the 73 reporting positive efficacy for headache. Many migraineurs have conditions that may be alleviated by stimulants. In addition, weight gain is often a concern, and a number of preventives may increase weight. In a small number of chronic migraine patients, stimulants may be beneficial for headaches as well as for associated comorbidities.
References:
- Haas DC, Sheehe PR. Dextroamphetamine pilot crossover trials and n of 1 trials in patients with chronic tension-type and migraine headache. Headache. 2004; 44(10):1029-37.
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