Tuesday, November 08, 2005

A new migraine prophylactic?

Memantine (brand name Namenda), marketed for Alzheimer's disease, was found possibly useful for migraine prevention. The drug antagonizes the NMDA receptor, blocking the action of glutamate, the primary excitory neurotransmitter in the brain. It makes sense that that would calm down the overexcitable processes thought to cause migraine.

Unfortunately, the study was small, so it does not have much statistical predictive power. Worse, it was open label. The patients knew they were getting the drug, so there was almost certainly a big placebo effect.

Another problem is that NMDA antagonists are known to cause brain damage, at least in rats, in doses that are not all that much higher than the therapeutic dose. So far the drug has mostly been tested on the demented elderly, which does not really rule out brain damage. I would not want to try memantine until several years of testing has been done on non-demented younger patients.

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