# Still Relevant, Still Effective: A Retrospective Observational Cohort Study on Real-Life Use of Flunarizine in Episodic Migraine

## TL;DR

This study shows that flunarizine is effective in reducing migraine frequency and disability in Turkish patients, despite some common side effects.

## Contribution

The study provides real-world evidence of flunarizine's efficacy and safety for episodic migraine prevention in a Turkish population.

## Key findings

- Flunarizine significantly reduced headache frequency, pain intensity, and disability in patients with episodic migraine.
- Common side effects included weight gain, tiredness, and mood changes, particularly in older patients.
- Early adverse events led to treatment discontinuation in some cases, emphasizing the need for close monitoring.

## Abstract

Aim: New disease-specific and mechanism-based treatments for migraine that share good evidence of efficacy have recently been introduced. However, due to reimbursement problems with insurance companies and high costs, classical anti-migraine drugs continue to be used. The objective of this study was to assess the clinical efficacy and tolerability of flunarizine for the preventive treatment of episodic migraine without aura in a Turkish cohort, concentrating on alterations in headache frequency, pain intensity, and migraine-related disability as measured by MIDAS scores within a practical clinical environment. Methods: Clinical and demographic data of 243 patients with episodic migraine without aura (175 females, 68 males; mean age 33.9 years) were evaluated. Headache frequency, side effects of flunarizine, pain intensity, and MIDAS scores were recorded during initial and 3-month follow-up periods. Results: After three months of flunarizine treatment, significant improvements were observed in headache parameters. The mean Numeric Pain Rating Scale (NPRS) score, the mean MIDAS score, and the monthly migraine attack frequency declined significantly (all p values < 0.001). Adverse events were reported in 21.8% of patients, most commonly weight gain and tiredness, followed by mood changes, gastrointestinal symptoms, and numbness or tingling. Patients experiencing side effects were significantly older (p = 0.023), though side effects did not impact treatment efficacy. Regression analysis identified no significant predictors of disability improvement. Conclusion: Our results demonstrated that flunarizine had considerable short-term efficacy in decreasing the frequency of migraine attacks, alleviating headache severity, and reducing migraine-related disability among patients experiencing episodic migraine without aura. Although mild to moderate side effects were fairly prevalent, especially in older individuals, they did not compromise the effectiveness of the treatment. Notably, early adverse events occurring within the first two weeks resulted in treatment discontinuation for some patients, highlighting the necessity for vigilant monitoring during the initial phase of treatment.