[The efficacy of different anticonvulsants in chronic daily headache].

Efficacy of 4 medications--topiramate, valproate, gabapentine and carbamazepine--was studied in 180 patients: 84 with chronic migraine, 63 with chronic headache of tension and 33 with a combination of the above types of headache. Mean age of the patients was 40,4+/-11,7 (from 19 to 65 years), most patients were female (n=152). The treatment was conducted during 12 weeks with assessment of efficacy every 2 weeks and 4 weeks after the end of the treatment. The response was high for all anticonvulsants, with the highest efficacy in chronic migraine. Among antidepressants used topiramate proved to be most effective. The use of anticonvulsants allows the reduction of the dosage of analgetics as much as twice and the complete withdrawal of the latter in 20% of cases.

[Comparative efficacy of betaserc and cinnarizine of vertigo in patients with migraine]. / Sravnetel'naia éffektivnost' betaserka i tsinnarizina pri lechenii golovokruzheniia u patsientov s migren'iu.

Headache and vertigo often emerge simultaneously. Fifty six (40%) out of 140 patients complaining of vertigo were studied. Emerging in the aura and/or in headache phases, vertigo was more frequently registered in patients suffered from migraine with aura (57%). Vertigo associated with migraine was diagnosed in 25% of the cases. The patients were randomized into 2 equal identical groups, one of which was treated by betaserc (16 mg, 3 times daily before meal) and the other one was given cinnarizine (25 mg, 3 times daily). Treatment duration was 12 weeks. Reduction of vertigo attacks frequency and headache by 50% and over, in comparison to the baseline period, was considered as beneficial. Fifty three (95%) patients completed the treatment course. Decrease of a risk for negative results and a frequency of positive effect of vertigo therapy were significantly higher in the group receiving betaserc. Reduction of monthly relapses by 50% and over was detected in 79% of the patients of betaserc group and in 52% of those of cinnarizine one. Migraine attacks monthly frequency was diminished by 43% and 64%, respectively. Therefore, betaserc is considered for using as vertigolytic medication and for migraine attacks prevention.

[A comparative efficiency of amitriptyline, fluoxetine and maprotiline in prevention of migraine in attack-free period]. / Sravnitel'naia éffektivnost' amitriptilina, fluoksetina i maprotilina pri lechenii migreni v mezhpristupnom periode.

To reduce frequency and severity of the attacks, migraine was treated preventively between the attacks. The most effective drugs were beta-blockers and antidepressants. In a single-blind study we estimated comparative efficiency of amitriptiline (inhibitor of noradrenaline and serotonin reuptake and 5-HT2-receptor antagonist) 12.5-25 mg/daily, fluoxetine (a selective serotonin reuptake inhibitor) 10-20 mg/daily, and maprotiline (a selective noradrenaline reuptake inhibitor) 10-25 mg/daily. The duration of the therapy of migraine between the attacks was 12 weeks. Each group included 20 patients. 46 patients completed the whole course of therapy: 14 patients received amitriptyline, 16 patients--fluoxetine, and 16 patients--maprotiline. Positive results of the treatment (a reduction of the frequency of the migraine attacks during a treatment by 50% as compared with the baseline period) were observed in 71% of the patients treated with amitriptyline, in 56% of the patients treated with fluoxetine, and in 38% of the patients treated with maprotiline. All the drugs were able to reduce both intensity and duration of a headache. Index of the Quality of Life in the patients with migraine was increased in the groups treated with either amitriptyline or fluoxetine, but not in a group treated with maprotiline. The results obtained agree with the notion about high efficiency of antidepressants given between migraine attacks. Amitriptyline and fluoxetine were more efficient in preventive therapy than maprotiline. These findings suggested indirectly, that the efficiency of antidepressants in treatment of migraine is explained by inhibition of serotonin reuptake and by 5-HT2-receptor antagonism, while influence on the inhibition of noradrenaline reuptake was not so significant.

[The effect of tropoxin on the neurogenic and vasogenic inflammation of the dura mater vessels]. / Vliianie tropoksina na neirogennoe i vazogennoe vospalenie sosudov tverdoi mozgovoi obolochki.

Subchronic administration of tropoxin (in doses of 7.5 and 10 mg/kg) caused dose-dependent blocking of 131I-albumin plasma transudation from the dura mater vessels, induced by electrical stimulation of the trigeminal ganglion and intravenous infusion of the agonist of 5-HT2B/2C receptors metachlorophenylpiperazine. The antimigraine agent metisergid produced a similar effect. A single injection of metisergid and tropoxin did not block albumin transudation. A 3 mg/kg dose of mianserin prevented the blocking effect of tropoxin and metisergid on plasma exudation into the dura mater. It is suggested that the mechanism of the tropoxin antimigraine effect is realized through the presynaptic 5-HT1 receptors of afferent endings of the trigeminal nerve and the postsynaptic 5-HT2B/2C receptors of the dura mater vessels.