Findings suggest potential benefits from an antipsychotic drug in treating status migrainosus.
Migraines are painful and, at times, can be downright debilitating.
As a first-line treatment, patients are typically treated with acetaminophen, nonsteroidal anti-inflammatory drugs, and caffeine. However, new findings published in inThe Neurohospitalistrevealed that an atypical antipsychotic used to treat schizophrenia may also serve as a treatment option for patients with status migrainosus, according toNeurology Advisor.
The antipsychotic Ziprasidone is known to modulate the dopaminergic system in a way similar to droperidol and haloperidol, according toNeurologyAdvisor. Furthermore, it has been shown to significantly alleviate chronic daily headache.
With this knowledge, neurologists at Barnes-Jewish Hospital began to treat status migrainosus patients with intramuscular ziprasidone in 2008. For the retrospective chart review, researchers analyzed data from 43 patients with status migrainosus treated with ziprasidone between 2008 and 2015,NeurologyAdvisorreported.
Data on the severity of migraines was available for 35 patients on admission and 39 patients on discharge, with a mean score of 8.9 ± 1.5 and 3.0 ± 2.9 on a 0-10 Likert scale, respectively.
According toNeurologyAdvisor, on average, 4.7 ± 2.5 different medications were administered prior to ziprasidone — no earlier than third-line.
There was available data for 34 patients on admission and discharge severity scores, with an average decrease in pain of 5.7 ± 3.0. Findings showed that ziprasidone was considered beneficial in reducing the severity of migraines in 81% of cases. Furthermore, the drug was linked to discharge in 65% of cases.
To examine how exactly ziprasidone affected length of stay, researchers compared the patients in the ziprasidone arm with 20 patients who received droperidol and other abortive treatments. The results showed that patients in the ziprasidone arm had a median length of stay of 3 days, with a range of 1 to 8 days.
Meanwhile those in the droperidol arm had a median length stay of 4 days, with a range of 2 to 17 days. Researchers also found that 12% of patients who received ziprasidone within 30 days of initial discharge experienced headache recurrence, according toNeurologyAdvisor.
Adverse events from ziprasidone included a period of consolidated sleep, which was found in nearly all of the patients, and single reports of rhinorrhea, upper back dystonia, and asymptomatic prolongation of QTc.
“Therefore, it is recommended that any patient with SM receiving ziprasidone have a baseline QTc of less than 500 milliseconds and that doses do not exceed 20 mg [of ziprasidone],” the study authors said, as reported byNeurologyAdvisor.
A limitation to the study included the lack of a control group and consistent, systematic documentation of migraine severity and treatment results. Indicating that more prospective, placebo-controlled studies are needed in order to confirm the efficacy and safety of ziprasidone formigraines, according to the researchers.
The report noted that overall the findings suggest ziprasidone may be an effective and fast-acting treatment option for patients with status migrainosus.