Magazine article Clinical Psychiatry News

Petasites, Tizanidine May Prevent Headache. (Herbal Product, Muscle Relaxant)

Magazine article Clinical Psychiatry News

Petasites, Tizanidine May Prevent Headache. (Herbal Product, Muscle Relaxant)

Article excerpt

DENVER--For preventing chronic headache, an herbal product called petasites and the muscle relaxant tizanidine performed favorably, based on data from double-blind clinical trials presented at the annual meeting of the American Academy of Neurology.

Also garnering attention were open-label studies of headache prevention using botulinum toxin type A injections, the antiepileptic agent topiramate, and the atypical antipsychotic agent quetiapine.

* Petasites. Dr. Richard B. Lipton, professor of neurology at Albert Einstein College of Medicine in New York, presented a 202-patient double-blind randomized trial of petasites, an extract from the plant Petasites hybridus, for migraine prophylaxis. After 4 months, patients receiving the herbal therapy had statistically significant reductions in the mean frequency of headaches, compared with baseline: The rate was 48% lower with petasites 75 mg b.i.d., 34% lower with petasites 30 mg b.i.d., and 26% lower with placebo.

Petasites is believed to prevent migraine by inhibiting peptidoleukotriene biosynthesis, possibly via calcium channel regulation. Petasites is marketed in the United States as Petadolex. Weber & Weber Biologische Arzneimittel, the German manufacturer of the herbal, sponsored the clinical trial. Dr. Lipton is a consultant to the company

* Tizanidine. This [[alpha].sub.2]-adrenergic agonist proved significantly more effective than placebo for headache prophylaxis in an 8 to 12-week double-blind trial involving 92 patients with chronic daily migraine, migrainous, or tension-type headache.

Headache index was the primary study end point. The index takes into account the number of headache days per month, the average headache intensity, and headache duration in hours. The index declined by 54% in the tizanidine group, compared with 19% with placebo, reported Alvin E. Lake III, Ph.D., of the Michigan Head Pain and Neurological Institute, Ann Arbor.

The median dosage of tizanidine used was 20 mg/day divided into three dosage intervals. But tolerability of the drug varied widely, ranging from 2 to 24 mg/day. And although the drug is usually thought of as a muscle relaxant, Dr. Lake doesn't believe that's the reason it helps prevent chronic daily headache. The relevant mechanism more likely involves inhibition of central [[alpha].sub.2] sensitization, he said.

The clinical trial was sponsored by Elan Pharmaceuticals, a company for which Dr. Lake has served as a consultant.

* Botulinum toxin. Dr. Eric J. Eross presented a pilot study in which 48 patients with episodic or chronic migraine headaches received botulinum toxin type A (BTX-A) in the standard 25-unit injection protocol used to treat facial wrinkles, supplemented by another 25-75 units injected into the cervical paraspinal muscles if tenderness was present.

At least a 50% reduction in disability was seen in 58% of patients at 3 months following the injections. In 40%, response was excellent, defined as a 75% or greater reduction in headache-associated disability. And 20% had a greater than 90% improvement in disability, reported Dr. Eross of the Mayo Clinic, Scottsdale, Ariz.

The best predictor of therapeutic response was the overuse of analgesics. …

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