Use of pizotifen in severe migraine: a long-term study.

Severe migraine attacks in 47 patients who were unresponsive to clonidine hydrochloride were treated with 1.5 mg pizotifen for a mean period of 6 month. The attack incidence, duration and severity were more than halved in 64% (30 patients), 25% becoming headache-free. Side-effects were not serious but weight gain was a problem in some subjects. Pizotifen administration allowed withdrawal of methysergide and ergotamine compounds without rebound headache. It appeared specially remedial in those whose migraine could be triggered by dietary factors. Follow-up 22 patients at 15 months confirmed these findings, 48.6% remaining 'improved' by the criteria of the trial (28% headache-free), and underlined the marked reduction in symptomatic drugs required and the absence of toxicity in long-term treatment.