Ziprasidone as a Potential Abortive Therapy for Status Migrainosus.
Migraine headache is among the most prevalent neurologic disorders. Status migrainosus often leads to hospitalization, and multiple medications are sometimes required for symptomatic relief. In 2008, neurologists at our institution started using the atypical antipsychotic ziprasidone as an abortive medication for status migrainosus. The Clinical Investigation Data Exploration Repository was used to search for patients admitted to the Barnes-Jewish Hospital inpatient neurology service with diagnoses of "headache" or "migraine." Patients were identified as having status migrainosus if they met the International Headache Society criteria for a migraine lasting >72 hours. Clinical records of identified patients were then entered into a secure online database (REDCap). Between 2008 and 2015, a total of 34 patients received 10 to 40 mg of ziprasidone for the treatment of status migrainosus. Among patients who received ziprasidone, headache severity decreased 5.68 ± 3.0 points on a 10-point scale, from admission to discharge. Ziprasidone was the last abortive medication added prior to discharge in 65% of cases. The 30-day readmission rate for migraine headache in patients who received ziprasidone was 12%. Ziprasidone was well tolerated, with side effects limited to a mild dystonic reaction (n = 1), rhinorrhea (n = 1), and a prolonged QTc of 495 milliseconds (n = 1). This observational study suggests that ziprasidone may be a safe, effective abortive medication for the treatment of status migrainosus. Further studies comparing ziprasidone to standard of care are warranted.
Department of Neurology, Washington University in St Louis, St Louis, MO, USA.
Eric C
EC
Landsness
Department of Neurology, University of Washington, Seattle, WA, USA.
Leo H
LH
Wang
Department of Neurology, Washington University in St Louis, St Louis, MO, USA.
Robert C
RC
Bucelli
headache disorders; migraine disorders; ziprasidone
Cephalalgia. 2014 Sep;34(10):725-44
25053747
Cephalalgia. 2005 Oct;25(10):822-6
16162260
Neurology. 2003 Jan 28;60(2):315-21
12552051
Cephalalgia. 2004;24 Suppl 1:9-160
14979299
Ther Adv Psychopharmacol. 2013 Jun;3(3):139-49
24167686
J Clin Psychiatry. 2005 Aug;66(8):989-96
16086613
Cephalalgia. 1998 May;18(4):174-82
9642491
Headache. 2006 May;46(5):781-7
16643581
J Clin Psychiatry. 2008 Dec;69(12):1869-79
19192477
Psychosomatics. 2013 Jan-Feb;54(1):1-13
23295003