The efficacy of combined low-doses of propranolol and flunarizine in episodic migraine

Abstract

This retrospective review is to evaluate the efficacy of a fixed combination of low doses of long - acting propranolol and flunarizine, when flunarizine mono therapy is ineffective in migraine. Thirty- five patients (ages 21-57 years; average 36.5 years; male-female ratio, 1:4) compatible with the diagnosis of migraine without aura received an initial single evening dose of flunarizine of 10 mg for a period of 8 weeks and none of them showed change of migraine attacks per month. These patients were divided into two treatment groups - Group A received a fixed combination of 20 mg. long acting propranolol and 5mg. flunarizine and group B received a fixed combination of 40mg. long acting propranolol and 10mg. flunarizine for a period of 8 weeks, without a "drug-free" period of observation. The patients were assessed at the end of 8 weeks period for differences in attack frequency, duration and intensity compared to the baseline as well as in both the treatment groups. Both groups showed significant reduction in the mean (±SD) of monthly migraine frequency, headache intensity, and headache duration (Wilcoxon Signed Rank test, significant at p≤ 0.01) when compared to baseline parameters. However, there was no significant difference in frequency, duration and severity (Mann–Whitney U test, not significant at p≤ 0.05) for both doses groups when compared. There was no adverse effect observed. This study suggests that the fixed dose combination of 20 mg propranolol and 5 mg flunarizine could be a new treatment initiative, especially for patients in whom flunarizine mono therapy is ineffective in migraine prophylaxis.