Agomelatine and migraine management: a successfully treated case series.

摘要: Headache is the most common reason for consultation in neurology departments Spain. Despite greater prevalence of tensional type headache, it migraine that accounts visits to specialists because a medical condition causing more disability. The burden caused by headaches well documented literature. It results days work or school missed, reduced labour productivity, etc. This field has undergone significant changes recent years, such as inclusion chronic new diagnostic classification [Headache Classification Subcommittee International Society, 2004], concept urgently needed be revised Committee et al. 2006] adapt real situation experienced patients. New therapeutic approaches include use triptans acute treatment and neuromodulators, particularly topiramate, preventive therapy [Linde 2013]. Melatonin physiologically associated with sleep induction maintenance [enhancing GABAergic system modulating γ-aminobutyric acid (GABA) receptor activity], dose-dependent analgesic effects [unknown mechanism related µ-opioid GABA(B) receptors], antioxidant effect (prevents free radical induced damage increases activity various enzymes glutathione S-transferase, reductase catalase), chronobiotic properties, moderate antihypertensive even intraocular pressure-reducing [Kurdi Patel, 2013]. also acts membrane stabilizer, serotonin modulator GABA potentiator, protects against glutamate-mediated neurotoxicity [Peres 2006]. Agomelatine modern antidepressant novel action. an MT1 MT2 melatonin agonist selective 5-HT2C antagonist. Its efficacy, which similar standard antidepressants, low risk sexual side effects, insomnia discontinuation syndromes, make interesting alternative management depression [Taylor 2014]. Some evidence from pilot experimental clinical trials [Guglielmo 2013; Tabeeva 2011] suggests melatonergic plays role pathogenesis drugs act on receptors may have migraine. We present case six patients comorbid who were successfully treated both conditions agomelatine. Presentation cases discussion A total 6 (measurement data shown Table 1), all them women, mean age 38.16 ± 10.45 seen at outpatient mental health clinics Recurrent Major Depressive Disorder [American Psychiatric Association’s Diagnostic Statistical Manual Mental Disorders IV Text Revision (DSM-IV-TR)]. All presented depressive episode [mean Montgomery-Asberg Depression Rating Scale (MADRS) score 26.66 3.72] time assessment. Their personal history included (based criteria 2004), onset 20 3.22 number attacks per month 3.83 1.83 pain intensity 9 0.89 measured Visual Analogue (VAS). In prophylactic (amitriptyline, beta-blockers topiramate) had been withdrawn due lack response adverse effects. Table 1. Case series: characteristics patients. Treatment agomelatine dose 25 mg was initiated episode. A 4 required increase 50 mg/24 hours remission after 8 weeks. After months follow up, (MADRS 1.16 1.16) there considerable reduction frequency attacks/month (0.66 1.41) (2 1.41). This observed first treatment. In these cases, we attribute improvement agomelatine, since past other antidepressants (venlafaxine, sertraline, duloxetine mirtazapine) no episodes, despite symptomatology. Our are those two studies, series, previously published efficacy prophylaxis 2011], although must mentioned our sample concomitant disorder, could introduce bias. antimigraine appears synergic action between agonism antagonism, though further studies clarify pathophysiological neurochemical mechanisms involved specific response.