Montastruc J L, Senard J M
Service de Pharmacologie Médicale et Clinique, INSERM U.317, Centre Midi-Pyrénées de Pharmacovigilance et d'Informations sur le Médicament, Faculté de Médecine, Toulouse, France.
Pathol Biol (Paris). 1992 Apr;40(4):381-8.
Calcium antagonists have been proposed for the prophylactic treatment of migraine because of their putative vasodilating antispasmodic effect and of their action against the cellular consequences of brain hypoxia. Published reports of controlled double-blind studies of calcium antagonists for the prophylactic treatment of migraine are reviewed herein. The effectiveness of verapamil, diltiazem, and nifedipine in this indication cannot be considered as firmly demonstrated, when problems with trial design and the amount of available data are taken into account. Nimodipine failed to demonstrate significant effectiveness in migraine with or without an aura. In contrast, the ability of a diphenylpiperazine, flunarizine, to decrease the incidence of migraine attacks in patients with common or classical migraine has been firmly demonstrated, although there is less evidence of this agent's effectiveness on the duration and severity of attacks. The percentage of patients who respond to flunarizine seems comparable to the percentages of propranolol or pizotifen responders. However, flunarizine is associated with unpleasant (weight gain) or severe (extrapyramidal or depressive symptoms) adverse effects which limit its place to that of a second-line drug. Lastly, the analysis of these studies failed to disclose a correlation between calcium movements across the cell membrane and effectiveness for the prevention of migraine attacks. Flunarizine's effect in migraine probably involves monoamine mechanisms which bear no relation to calcium.
由于钙拮抗剂具有假定的血管舒张解痉作用以及对脑缺氧细胞后果的作用，已有人提出将其用于偏头痛的预防性治疗。本文回顾了已发表的关于钙拮抗剂预防性治疗偏头痛的对照双盲研究报告。考虑到试验设计问题和现有数据量，维拉帕米、地尔硫䓬和硝苯地平在该适应症中的有效性不能被视为已得到确凿证实。尼莫地平在有无先兆偏头痛中均未显示出显著疗效。相比之下，二苯哌嗪类药物氟桂利嗪降低普通型或典型偏头痛患者偏头痛发作发生率的能力已得到确凿证实，尽管关于该药物对发作持续时间和严重程度有效性的证据较少。对氟桂利嗪有反应的患者百分比似乎与对普萘洛尔或苯噻啶有反应的患者百分比相当。然而，氟桂利嗪会产生令人不适的（体重增加）或严重的（锥体外系或抑郁症状）不良反应，这限制了它只能作为二线药物使用。最后，对这些研究的分析未能揭示细胞膜钙转运与预防偏头痛发作有效性之间的相关性。氟桂利嗪在偏头痛中的作用可能涉及与钙无关的单胺机制。
