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Namenda for Migraine and Chronic Headache Prevention

by Teri Robert, Lead Expert, and Dr. John Claude Krusz

There are no medications available that were developed for the purpose of Migraine and headache prevention. However, there are over 100 medications that are now successfully being used for that purpose. We now have both anecdotal and clinical evidence that Namenda can be effective in the prevention of Migraine and headache.

Namenda (memantine HCL, Forest Pharmaceuticals) was approved for use in the United States in October, 2003, more than a decade after its use began in Europe under the brand names Ebixa and Axura. It's classified as an orally active NMDA receptor antagonist. Namenda (memantine hydrochloride) is approved for the treatment of "moderate to severe dementia of the Alzheimer's type."

Medications can also be utilized for off-label purposes when they're noticed to help other conditions. The vast majority of medications prescribed for headache and Migraine prevention are actually prescribed off-label.

John Claude Krusz, Ph.D., M.D., and Diane Cammarata, APRN, BC, conducted an open label trial of the use of Namenda in the treatment of chronic Migraine disease and tension-type headache (TTH) in Dr. Krusz's Dallas practice. The results have been quite promising.

Study Rationale/Objectives:
"We wanted to explore the efficacy of blockade of NMDA receptors in the treatment of Migraines and chronic tension-type headaches using a low-affinity antagonist, memantine. If one considers that there might be a commonality or overlap of signal barrage to the spinal cord or brainstem in chronic pain and chronic headache states, the glutamate system might be a point of amplification or reinforcement of the pain transmission cascade in these clinical conditions. In particular, memantine blocks excessive NMDA receptor activity without disrupting normal activity. Memantine does this through its action as an uncompetitive, low-affinity, open channel blocker; it enters the receptor-associated ion channel preferentially when it is excessively open, and, most importantly, its off-rate is relatively fast so that it does not substantially accumulate in the channel to interfere with normal synaptic transmission1-4. Numerous studies, both in animal models and in human clinical pain states, have demonstrated the ability of memantine to alter pain behaviors or parameters5-7; some studies failed to demonstrate clinical efficacy. No prior data exists in treating Migraine or TTH. The primary objective in this open-label study was to treat a cohort of refractory clinic patients from our clinic with memantine to see if the Migraine and headache patterns would change over time. The primary objective was to look for a reduction in the frequency of Migraines per month. The secondary objective consisted of reduction in tension-type headache frequency and severity."

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