Migraine and Other Headaches

Shapera, Pittsburgh Medical Bulletin (1940),338 reported that two of four cases of migraine were improved with PHT.

338. Shapera, W., Dilantin therapy in certain nervous disorders, Pittsburgh Med. Bull., 29: 732-736, 1940.

McCullagh and Ingram, Diseases of the Nervous System (1956),235 in their paper “Headaches and Hot Tempers,” reported that their experience showed that PHT was by far the most useful medication in the treatment of a syndrome in which migraine headaches were related to familial cerebral dysrhythmias.

235. McCullagh, W. M. and Ingram, W., Jr., Headaches and hot tempers, Dis. Nerv. Syst., 17: 279-281, 1956.

Kellaway, Crawley and Kagawa, Epilepsia (1959-1960),551 in a report on 459 children, found PHT one of the drugs of choice in the treatment of headache accompanied by 14- and 6-per-second positive spike patterns.

551. Kellaway, P.,Crawley,I.W.,and Kagawa, N., Paroxysmal pain and autonomic disturbances of cerebral origin: a specific electro-clinical syndrome, Epilepsia, 1: 466-483, 1959-1960.

Hirschmann, Therapeutische Umschau (1964),161 reported on a study of forty-four patients with migraine not relieved by ergot preparations alone. Of these, thirty-two remained in treatment. When they were treated with a combination of PHT, caffeine and ergot, nineteen were either completely relieved or had less frequent or milder attacks.

161. Hirschmann, J., On the interval treatment of migraine, Ther. Umsch., 21; 48-51, 1964.

Wiedemann, Medizinische Monatsschrift (1966),380 in a series of studies on migraine, found preparations containing PHT and caffeine useful in the treatment of a variety of neuraigias and cephalaigias. This treatment was particularly suitable for patients with true migraine and trigeminal neuralgia.

380. Weidemann, D. H., New viewpoints on migraine therapy, Med. Mschr., 20: 28-30, 1966.

Jonas, Headache (1967),693 administered PHT to eighteen migraine sufferers. Nine patients afflicted with paroxysmal migraine experienced complete relief. Of six non-paroxysmal patients, four benefited by the use of PHT.

693. Jonas, A. D., The distinction between paroxysmal and non-paroxysmal migraine, Headache, 79-84, July, 1967.

Caplan, Weiner, Weintraub, Austen, Headache (1976),1763 reported the successful use of PHT in the treatment of a fifty-five-year-old male patient with neurological dysfunction accompanied by classic migraine headaches following cardiac surgery. The patient was experiencing episodes of neurological dysfunction manifested by tingling, numbness, weakness and pain in the hands, arms, thighs and face, inability at times to find words, slow speech, and dysarthria with repetitive speech. With PHT, 100 mg t.i.d., no further episodes occurred. On follow-up three years later, the patient continued to do well on PHT.

1763. Caplan, L. R., Weiner, H., Weintraub, R., M. and Austen, W. G., “Migrainous” neurologic dysfunction in patients with prosthetic cardiac valves, Headache, 16: 218-21, 1976.

Millichap, Child’s Brain (1978),1987 found PHT effective in relieving severe recurrent headaches associated with other symptoms, including nausea, vomiting, dizziness and vertigo, in forty-seven of seventy children.

1987. Millichap, J. G., Recurrent headaches in 100 children, Child’s Brain, 4: 95-105, 1978.

Swanson and Vick, Neurology (1978),2096 treated three cases of basilar artery migraine with PHT, 300 mg daily. In two cases the attacks were completely relieved. In the third case the frequency and severity of the attacks were reduced.

2096. Swanson, J. W. and Vick, N. A., Basilar artery migraine, Neurology, 28: 782-6, 1978.

Weill, Journal of Nervous and Mental Diseases (1962), 3239 observed 236 patients with migraine. The authors found that of the fifty-nine patients with dysrhythmic EEG records, treatment with drugs usually effective in ordinary migraine (i.e., caffeine, ergotamine tartrate, dihydroergotamine etc.) was of little benefit. However, with the addition of PHT or Mesantoin, rapid therapeutic improvement was usually noticeable.

3239. Weil, A.A., Observations on dysrhythmic migraine, J. Nerv. Ment. Dis., 134: 277-81, 1962.

Smyth and Winter, Electroencephalography and Clinical Neurophysiology (1963), 3240 studied 392 migraine patients, of which 64 showed spontaneous delta activity in the EEG and were labeled "dysrhythmic migraine." Forty of these patients were given PHT and studied over a period of 2 years. Eighty percent showed improvement in symptoms.

3240. Smyth, V.O. and Winter, A.L., Dysrhythmic migraine, Electroencephalogr. Clin. Neurophysiol., 15: 912-3, 1963.

Raskin and Appenzeller, Headache, (1980), 3241 in a review of various therapies for migraine, PHT studies by other investigators are cited. The authors expressed the need for an adequately controlled study utilizing PHT in migraine. They stated that no other unestablished drug has equaled the empiral usage (of PHT) over such an extended period. "It is the authors' view that PHT and primidone probably have a role in the prophylaxis of migraine, and that their effects may be mediated independent of their anticonvulsant properties via effects on serotonergic synapses."

3241. Raskin, N.H. and Appenzeller, O., Migraine: Treatment and clinical pharmacology, Headache, 111-171, W. B. Saunders, Philadelphia, PA, 1980.

Raffaelli, Martins and Dagua Filho, Functional Neurology (1986), 3242 conducted a comparative study of two groups of patients with common migraine and reactive osmophobia. Fourteen patients (group I) and seventeen patients (group II) received treatment for headache with propranolol, amitriptyline or methisergide. The seventeen patients in group II were also given phenytoin 100 mg/day. At the end of six months of treatment, three (21.42%) of the patients in Group I (without PHT) and eleven (64.7%) of those in group II (with PHT) had improvement in their osmophobia.

3242. Raffaelli, E., Martins, O.J., and Dagua Filho, A., A role for anticonvulsants in migraine, Funct. Neurol., 1(4): 495-8, 1986.

Robbins, Headache (1989), 3243 presents a patient who began to experience continuous right frontal headaches, nausea, occasional flashing lights in her left peripheral visual field, visual blurring, light-headedness and difficulty concentrating after an automobile accident. Amitriptyline (25 mg qhs) and fenoprofen 600 mg b.i.d.gave no relief and were discontinued. Two days after beginning phenytoin (200 mg every morning), the headaches were markedly decreased and the flashing lights were gone. After one month, the patient stopped the PHT. The headaches and flashing lights returned. Upon resumption of PHT, the patient's symptoms were again relieved.

3243. Robbins, L., Post-traumatic headache with scintillating scotoma treated with phenytoin (dilantin), Headache, 29: 515-516, 1989.

Wang, Qi, Lu and Huang, National Workshop of Clinical Use of Phenytoin, Chengdu, China (1995), 3244 reported their successful use of phenytoin to treat 40 of 48 patients suffering from migraine attacks. Before giving phenytoin (100 mg tid) for the attacks that had occurred over a period of 3 months to 21 years, all analgesics were stopped. The authors found that, within 3 months 22 cases were cured; 18 cases were improved in 1 month and without attacks within 3 months. Eight cases were uncontrolled within the 3-month treatment period.

3244. Wang, J., Qi, L., Lu, Q., and Huang, M., The effect of phenytoin on migraine, Presented at the National Workshop of Clinical Use of Phenytoin, Chengdu, China, 1995.

See also Ref.

3245. Mathew, N.T., Headache, Conn's Current Therapy, 864-879, Rakel, R.W., Ed., W. B. Saunders, Philadelphia, PA, 1994.

3246. Swerdlow, M., The use of anticonvulsants in the management of cancer pain, The Pain Clinic I, Proceedings of the First International Symposium, 61-70, Erdmann, W., et al, Eds., VNU Science Press, Utrecht, 1985.