Another medication can now be added to the growing list of medications shown to be effective for prevention of headaches and Migraine attacks. Namenda (memantine HCL, Forest Pharmaceuticals) was approved for use in the United States in October, 2003, more than a decade after its use began in Europe under the brand names Ebixa and Axura. It's classified as an orally active NMDA receptor antagonist. Namenda (memantine hydrochloride) is approved for the treatment of "moderate to severe dementia of the Alzheimer's type."
Medications can also be utilized for off-label purposes when they're noticed to help other conditions. The vast majority of medications prescribed for headache and Migraine prevention are actually prescribed off-label.
John Claude Krusz, Ph.D., M.D., and Diane Cammarata, APRN, BC, have been studying the use of Namenda in the treatment of chronic Migraine disease and tension-type headache (TTH) in Dr. Krusz's Dallas practice. The results have been quite promising.
Krusz and Cammarata studied the efficacy of memantine, a new moderate affinity NMDA receptor antagonist in the treatment of chronic Migraines and tension-type headaches (TTH). The primary endpoint of this open label study was reduction of frequency and severity of Migraines. Secondary endpoints included reduction of TTH and pain related to the head and neck in our study patients.
Twenty patients with chronic Migraines who had not responded to other prophylaxis measures were studied. They had an average of 9.2 Migraines per month. Fourteen of 20 (60%) had TTH as well (average of 12.5 days per month). Memantine was added at 5mg per day with weekly increases of 5 mg, up to a maximum of 20 mg per day, as tolerated. Patients kept headache diaries for Migraines and TTH as well as pain scores. Evaluations were made after one month of therapy on 20 mg (or maximally tolerated dose) of memantine.
Migraine frequency fell to an average of 4.1 Migraines per month, or almost 56% less than at baseline, in 14 of 20 patients. Remaining Migraines were rated as less severe and easier to treat. Acute Migraine and rescue medication use dropped by two-thirds. TTH frequency fell by 62%, to 6 headaches per month. 6 patients saw no response of their Migraines to memantine. 4 patients reported dizziness and one nausea. 2 of these patients had betterment of their Migraines. Acute migraine and rescue medication use dropped by two-thirds.
Krusz and Cammarata conclude from this preliminary open-label study that memantine has the ability to offer successful prevention of chronic Migraines and TTH in situations where other regimens have not benefited the patient. It speaks to the potential role of NMDA glutamate receptors in the maintenance of Migraine and headache states. Memantine should be studied in Migraine therapy in a double-blind manner.
>>To view graphs or a copy of the poster presentation of this study, please click HERE.<<
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Resources:
Krusz, John Claude, Ph.D., M.D.;
Cammarata, Diane, APRN, BC. "Memantine for Chronic Migraine Prophylaxis." Poster
presentation to the annual conference of the American Headache Society,
Philadelphia, June,
2005; and the European Federation of Neurologic Societies conference, Athens,
Greece, September, 2005.
Published November 7, 2005
