Article: PDF OnlyFlunarizine in Migraine Prophylaxis The Clinical ExperienceSchmidt, Rainer; Oestreich, WolfgangAuthor Information Medical Department and *Medical Development Department, Janssen GmbH, Neuss, Germany Journal of Cardiovascular Pharmacology: Volume 18 - Issue - p S21-S26 Free Abstract Apart from the treatment of migraine attacks, prophylaxis may be required when certain criteria of frequency, duration, or severity are met. In a series of placebo-controlled, double-blind studies, the effectiveness of the cerebral calcium antagonist flunarizine (Sibelium) in migraine prophylaxis was shown. In further investigations, the effectiveness of flunarizine was similar to that of propranolol, metoprolol, pizotifene, and methysergide. The side effects described for treatment with flunarizine were somnolence, weight gain, and, in rare cases, depressive mood and extra-pyramidal motor disorders. Considering the benefit/risk relation, flunarizine and the β-adrenergic agents propranolol and metoprolol are now regarded as the drugs of choice. The mechanism of action of flunarizine in migraine prophylaxis is largely unexplained, but the antihypoxic effect of flunarizine is discussed in this context. The search for predicting factors for a successful treatment with flunarizine and the investigation of an injectable solution for the treatment of acute migraine attacks must be left to future research. Copyright © 1991 Wolters Kluwer Health, Inc. All rights reserved.