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Migraine: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Methysergide is an effective migraine prophylactic drug. Side-effects include transient muscle aching, claudication, abdominal distress, nausea, weight gain, and hallucinations. Frightening hallucinations after the first dose are not uncommon.119 The major complication of methysergide is the rare (1/2500) development of retroperitoneal, pulmonary, or endocardial fibrosis, the unreasonable fear of which prevents its more widespread use.116 To prevent this complication, a medication-free interval of 4 weeks following each 6–month course of continuous treatment is recommended. We find methysergide to be a very effective drug with minimal side-effects, but we reserve its use because of the need for a drug holiday.7
Origins of RSD
Published in Hooshang Hooshmand, Chronic Pain, 2018
Methysergide acts as a serotonin antagonist in CNS and relieves vascular headaches between attacks. In contrast to sumptriptan and ergotamines, it has no effect on an acute ongoing attack. It has an inhibitory influence on brain stem nuclei. This inhibitory effect is mainly on the presynaptic function of serotonin. Periactin and methysergide, the antagonists of presynaptic serotonin, reduce the excitability of the raphe nuclei of the brain stem. Electrical stimulation of the raphe nuclei stimulates the formation of serotonin and the release of serotonin to the extracellular synaptic cleft.
Neurological conditions
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Prophylaxis against migraine attacks in pregnancy is best provided by low-dose aspirin or amitriptyline (commencing with low doses such as 10 mg per day). Propranolol and atenolol have been used, with the awareness of the associated potential for intrauterine growth restriction. The safety of pizotifen and methysergide in pregnancy is still in question.
Drug profile: galcanezumab for prevention of cluster headache
Published in Expert Review of Neurotherapeutics, 2021
Dharani Mudugal, Teshamae S. Monteith
Only a few other oral treatments exist for preventive use [Table 3]. Lithium requires monitoring and is associated with intolerable side effects including nephrotoxicity, thyroid dysfunction, extrapyramidal symptoms, and weight gain to name a few. Methysergide, an effective preventive treatment for some cluster sufferers, is no longer available on the market, sometime after the European Medicines Agency recommended restricted use owing to concerns of organ fibrosis. The role of topiramate was examined in several studies for CH prevention. The largest one was an open trial that enrolled 33 patients; 10 with chronic and 23 with episodic CH. The results were not statistically significant in terms of showing a reduction in headache frequency [20].
Current advances in the management of cluster headaches
Published in Expert Opinion on Pharmacotherapy, 2021
Theodoros Mavridis, Marianthi Breza, Christina Deligianni, Dimos D. Mitsikostas
Medications such as pizotifen, capsaicin, melatonin, indomethacin and others may have some usefulness as alternative options for patients with medically refractory CH [56–62]. Only limited data from mostly uncontrolled studies support their use. Methysergide, an ergot derivative, has been known as an effective treatment for migraine and cluster headache, but with many concerns regarding its safety. EMA and HIS concluded “that the vast majority of headache experts in this survey regarded methysergide a unique treatment option for specific populations for which there are no alternatives, with an urgent need to continue its availability’ [63]. Pharmaceutical companies have ceased production of methysergide and it is not available in most countries.
Cluster headache therapies: pharmacology and mode of action
Published in Expert Review of Clinical Pharmacology, 2020
Jasper Mecklenburg, Margarita Sanchez Del Rio, Uwe Reuter
Methysergide, an unspecific 5-HT1 receptor agonist, is not used anymore due to its unfavorable side effect profile. The drug is another ergot derivate, and open-label studies have documented efficacy for preventive usage [154].