Tolerability and efficacy of memantine as add on therapy in patients with refractory migraine

Prophylactic migraine treatment has always been a challenge. Efficacy and tolerability are two main issues in current approved migraine prevention regimens. Since some migraineurs patients fail approved preventative agents, experts are always seeking newer agents. Memantine, a glutaminergic antagonist, could potentially be one of these agents. Objective of current study is assessing the efficacy of memantine as a preventative migraine treatment and its potential side effects. In this study, 127 migraineurs patients meeting the criteria for starting preventative therapy (> 4 headache days/month) were included. All patients previously failed at least one trial of adequate preventive therapy. After a 30-day baseline observation, patients started memantine for 3 months, beginning at 5 mg/day, which increased by 5 mg/week up to a maximum of 20 mg a day if symptoms did not improve. Headache frequency, duration, and severity were assessed at the end of the treatment phase. 102 patients completed the study. In the study population, headache frequency reduced from 9.9 days/month at baseline to 5 days/month at 3 months (P < .001). The mean severity of pain reduced from 6.9 to 3.6 at 3 months (P < .001). Headache duration significantly reduced at 3 months, compared with baseline (P < .001). Side effects related to memantine consumption were uncommon and generally mild. Based on preliminary data, there is some evidence that memantine might be useful in the treatment of refractory migraine. This is in line with previous pilot and open label studies. However, double blind studies are still needed.