IV verapamil successfully aborts familial hemiplegic migraine

מתוך medicontext.co.il

By Megan Rauscher

NEW YORK (Reuters Health) – Intravenous administration of the calcium channel blocker verapamil may have a role in the treatment of patients with acute familial hemiplegic migraine, two neurologists from the University of Missouri in Colombia say.

In the November 13th issue of the journal Neurology, Drs. Wengui Yu and Steven H. Horowitz describe a 28-year-old woman with progressively more severe and frequent hemiplegic migraine attacks refractory to numerous agents including oral verapamil.

Five milligrams verapamil via IV push within 30 minutes of onset successfully aborted 5 hemiplegic migraine attacks over 3 days, the researchers report.

In comments to Reuters Health, Dr. Yu noted that gene mutations within the brain-specific calcium channel were initially identified in familial hemiplegic migraine in 1996 and were confirmed in numerous studies in the last few years. "This is the most significant discovery in medical genetics of human migraine," he said, "and suggests that calcium channel mutations cause the calcium channel malfunction and hemiplegic migraine attacks."

"It is therefore not difficult to understand why IV verapamil has successfully aborted the acute hemiplegic migraine attacks in our patient," Dr. Yu said.

He and his colleague have since treated a few more cases of sporadic hemiplegic migraine with IV verapamil and the response has been "consistently very positive," Dr. Yu added.

Familial hemiplegic migraine is often misdiagnosed as stroke or conversion disorder due to its complicated clinical presentation and poor responsiveness to common migraine medication, Dr. Yu noted. "Patients are often very frustrated with this disabling condition and physicians can also find very little information in the literature on the treatment of this illness."

"Hopefully, the genetic breakthrough in familial hemiplegic migraine will stimulate more clinic research and lead to new effective treatment in hemiplegic migraine," he said.

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