Comparative Efficacy of Calcium Antagonist Drugs in the Prophylaxis of Migraine

SYNOPSIS Since 1981, numerous studies have shown the efficacy of calcium antagonist drugs in the prophylaxis of migraine. Five different agents: flunarizine, nimodipine, verapamil, nifedipine, and diltiazem, have been evaluated. This paper reviews these studies with regard to reduction in migraine frequency, percentage of patients showing improvement, percentage of patients showing 50% or greater improvement, and adverse reactions. These studies show that these five calcium channel blockers are effective in migraine prophylaxis. Comparison of data suggest no major differences between the five agents reviewed with regard to efficacy. Furthermore, adverse reactions were divided between vascular and gastrointestinal with the “systemically active” drugs, and behavioral and muscular with the “cerebro‐specific” drugs. Lastly, most trials show a therapeutic delay of 3 to 8 weeks with the calcium channel blockers.