title: Safety and efficacy of flunarizine in childhood migraine: 11 years' experience, with emphasis on its effect in hemiplegic migraine.
abstract: OBJECTIVE
  The aim of this study was to report a single-centre experience of flunarizine in childhood migraine with focus on safety and efficacy.
  
  
  METHODS
  We conducted a retrospective observational audit of 72 individuals (40 male, 32 female; mean age 13y; age range 1y 6mo-17y) at a tertiary paediatric neurology unit between 1998 and 2009. Children were included if they had a diagnosis of migraine and at least one follow-up assessment and a minimum of 3 months' treatment with flunarizine.
  
  
  RESULTS
  Of 102 individuals identified, 30 were excluded for the following reasons: no outcome data (n=13), non-migraineurs (n=9), missing records (n=4), or inadequate treatment duration (n=4). Of the final cohort (72 individuals), 44 had migraine without aura, 15 had migraine with aura or childhood migraine equivalents, eight had sporadic hemiplegic migraine, and five had familial hemiplegic migraine. The median age was 13 years (1y 6mo-17y) and median duration of migraine was 48 months. Starting dose was 5mg. Other doses used were 2.5mg (three individuals), 7.5mg (one individual), and 10mg (six individuals). Treatment duration was 12 months. Successful prophylaxis, defined as at least a 50% reduction in attack frequency, was observed in 57% (41/72). Response rate was higher among those with hemiplegic migraines (85%) than in those who did not have hemiplegic migraines (51%). Side effects were noted in 15 (21%) individuals (depression, n=6; weight gain/increased appetite, n=5; tiredness/sedation, n=2; and worsening headache, n=2), and led to discontinuation of treatment in 13.
  
  
  CONCLUSIONS
  In our cohort of children with migraine, flunarizine appears to be more effective in the hemiplegic migraine group. Adverse effects were seen in one-fifth of the individuals, leading to discontinuation in 18%.
authors.affiliation: Children's Headache Clinic, Great Ormond Street Hospital, London, UK.
authors.forename: Basheer
authors.initials: B
authors.lastname: Peer Mohamed
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
authors.forename: Prab
authors.initials: P
authors.lastname: Prabhakar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005444:Flunarizine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D020325:Migraine with Aura / Q000188:drug therapy*; D010372:Pediatrics; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D005444:Flunarizine