Krusz and Cammarata studied the efficacy of memantine, a moderate affinity NMDA receptor antagonist in the treatment of chronic Migraines and tension-type headaches (TTH). The primary endpoint of this open label study was reduction of frequency and severity of Migraines. Secondary endpoints included reduction of TTH and pain related to the head and neck in our study patients.
Twenty patients with chronic Migraines who had not responded to other prophylaxis measures were studied. They had an average of 9.2 Migraines per month. Fourteen of 20 (60%) had TTH as well (average of 12.5 days per month). Memantine was added at 5mg per day with weekly increases of 5 mg, up to a maximum of 20 mg per day, as tolerated. Patients kept headache diaries for Migraines and TTH as well as pain scores. Evaluations were made after one month of therapy on 20 mg (or maximally tolerated dose) of memantine.
Results:
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The average length of treatment, including the initial titration of memantine dosage, was 4.6 months, with an average daily dosage of 19.25mg (range= 10-20mg/day).
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Migraine frequency fell to an average of 4.1 Migraines per month, or almost 56% less than at baseline, in 14 of 20 patients.
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Remaining Migraines were rated as less severe and easier to treat.
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Acute Migraine and rescue medication use dropped by two-thirds.
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TTH frequency fell by 62%, to 6 headaches per month.
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6 patients saw no response of their Migraines to memantine.
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4 patients reported dizziness and one nausea. 2 of these patients had betterment of their Migraines.
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Acute migraine and rescue medication use dropped by two-thirds.
Conclusions:
Krusz and Cammarata conclude from this preliminary open-label study that memantine has the ability to offer successful prevention of chronic Migraines and TTH in situations where other regimens have not benefited the patient. It speaks to the potential role of NMDA glutamate receptors in the maintenance of Migraine and headache states. Memantine should be studied in Migraine therapy in a double-blind manner.
