Neurol India Home 

Year : 2005  |  Volume : 53  |  Issue : 2  |  Page : 243-

Preventive therapy of migraine

Sudhir Kumar 
 Department of Neurological Sciences, Apollo Hospitals, Hyderabad, India

Correspondence Address:
Sudhir Kumar
Department of Neurological Sciences, Apollo Hospitals, Hyderabad

How to cite this article:
Kumar S. Preventive therapy of migraine.Neurol India 2005;53:243-243

How to cite this URL:
Kumar S. Preventive therapy of migraine. Neurol India [serial online] 2005 [cited 2020 Jul 10 ];53:243-243
Available from:

Full Text


I read with interest the recent report of acute myopia induced by topiramate used for migraine prophylaxis.[1] I would like to make certain observations.

Firstly, Bhattacharyya et al used two medications (flunarizine and topiramate) as the initial preventive treatment of migraine. However, the guidelines recommend usage of a single drug. The drug should be considered a failure only after an adequate trial (2-3 months) has been given.[2] After the failure of the first drug, one has the option of using another drug or a two-drug combination. Also, Bhattacharyya et al have used two second-line agents for migraine prevention at the onset. However, guidelines recommend using a first-line agent initially, which include propranolol, divalproex sodium, sodium valproate and amitryptiline among others.[2],[3] Considering the fact that adverse effects are common with most of the drugs used for migraine prevention, one should be cautious in starting two second-line drugs as the first step.

Secondly, the choice of agent should also be individualized depending on the patient profile. Bhattacharyya et al started flunarizine in an obese patient (on sibutramine for the same). Weight gain as a side effect of flunarizine is well known.[4]


1Bhattacharyya KB, Basu S. Acute myopia induced by topiramate: Report of a case and review of the literature. Neurol India 2005;53:108-109.
2Snow V, Weiss K, Wall EM, Mottur-Pilson C; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med 2002;137:840-9.
3Geraud G, Lanteri-Minet M, Lucas C, Valade D; French Society for the Study of Migraine Headache (SFEMC). French guidelines for the diagnosis and management of migraine in adults and children. Clin Ther 2004;26:1305-18.
4Thomas M, Behari M, Ahuja GK. Flunarizine in migraine prophylaxis: an Indian trial. Headache 1991;31:613-5.