From: Histamine and migraine revisited: mechanisms and possible drug targets
Type (Ligand) | Participants | Daily dose | Duration | Main findings | First author (year) |
---|---|---|---|---|---|
H1 antagonist (cyproheptadine) vs. 5HT antagonist (methysergide) vs. Bellergalb vs. placebo | 453a | 12–24 mg 6 mg NA NA | 6 months | Clinical improvement (Headache free or substantial improvement)c: methysergide 64%, cyproheptadine 46%, Bellergal 34%, placebo 20%. | Curran (1964) (12) |
Antihistaminic drug (pizotifen) | 32a | 1.5–2 mg | NA | Cessation or attenuation of attacks in 33%. Significant reduction in migraine days and increased response to acute medication in 40%. Increased resilience against induced attacks. AEd: weight gain and drowsiness. | Sicuteri (1967) (13) |
Antihistaminic drug (pizotifen) | 11 MAe 27 MOf 2 Cluster headache | 1.5 mg (1–3 mg) | 2–6 mo: 16 > 6 mo: 17 | Significant (42.5%) clinical improvement compared to previous placebo reports (Curran 1964). | Selby (1970) (14) |
H1 antagonist (cyproheptadine) vs. antihistaminic drug (pizotifen) vs. antihistaminic drug (methdilazine) | 165a | 12–24 mg 4.5–9 mg 16–32 mg | 4 weeks | Clinical improvement: pizotifen 58%, methdilazine 41%, cyproheptadine 40% No placebo control. | Lance (1970) (15) |
Antihistaminic drug (pizotifen) vs. 5HT antagonist (divascan) vs placebo | 4 MAe 26 MOf | 3 mg 15 mg | 8 weeks | Significant lowered attack rate with pizotifen. AEd: weight gain and drowsiness. | Osterman (1977) (16) |
Antihistaminic drug (pizotifen) vs placebo | 28a | 3 mg | 12 weeks | Complete resolution in 6 cases, reduced frequency and severity in 6 and no improvement in 2 cases. No improvement in the placebo group. AEd: weight gain and dizziness. | Lawrence (1977) (17) |
H2 (cimetidine) vs. H2 and H1 combined (cimetidine and chlorpheniramine) vs. placebo | 24 MO 1 basilar migraine | 200 mg cimetidine 4 mg chlor pheniramine | 1 week | No significant improvement over placebo with H2 antagonist alone or in combination with H1antagonist. AEd: weight gain and drowsiness. | Anthony (1978) (18) |
H2 (cimetidine) vs. H2 and H1 combined (cimetidine and chlorpheniramine) vs. placebo | 6 MA 28 MO | 200 mg cimetidine 4 mg chlor-pheniramine | 12 weeks | No significant improvement over placebo with H2 antagonist alone or in combination with H1antagonist. AEd: weight gain and drowsiness. | Nanda (1980) (20) |
H1 (cinnarizine) | 11MAe 69 MOf | 75 mg | 14 weeks | Significant reduction in migraine days and use of acute medication. AEd: weight gain, drowsiness, mild reversible depression and dyspepsia. Open label. Dropout rate 3.75%. | Rossi (2003) (22) |
H1 (cinnarizine) | 60g | Up to 75 mg | 12 weeks | Significant reduction in migraine days. AEd: Palpitations and dizziness. Open label. Dropout rate 5%. | Togha (2006) (21) |
H1 (cinnarizine) vs valproate | 86 MOf 18 MAe | 50 mg Cinnarizine 400 mg valproate | 12 weeks | Valproate more effective than cinnarizine. AEd: Dry mouth, fatigue and somnolens as the most frequent. No placebo control. Dropout rate: 23% cinnarizine, 19.4% valproate. | Bostani (2013) (23) |
H1 (cinnarizine) vs placebo | 68 children (5-17y)a | 50 mg or 1.5 mg/kg(> 30 kg) | 12 weeks | Significant better than placebo to reduce headache frequency by at least 50% reduction. AEd: weight gain and drowsiness. Dropout rate: 12% cinnarizine, 5% placebo. | Ashrafi (2014) (24) |