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Dextromethorphan/Quinidine in Migraine Prophylaxis

An Open-label Observational Clinical Study

Berkovich, Regina R. MD, PhD*; Sokolov, Alexey Y. MD, PhD; Togasaki, Daniel M. MD, PhD; Yakupova, Aida A. MD, PhD§; Cesar, Paul-Henry MD; Sahai-Srivastava, Soma MD

doi: 10.1097/WNF.0000000000000272
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Objective This study aimed to assess potential efficacy and safety of dextromethorphan/quinidine (DMQ) in prophylactic treatment of migraine in patients with multiple sclerosis (MS) with superimposed pseudobulbar affect (PBA).

Methods Multiple sclerosis patients with superimposed PBA and comorbid migraine were enrolled into this open-label observational study at the University of Southern California Comprehensive MS Center. The baseline characteristics included, among other data, frequency and severity of acute migraine attacks and use of migraine relievers. The DMQ was used exclusively per its primary indication — PBA symptoms control — 20/10 mg orally, twice a day for the mean of 4.5 months (the shortest exposure registered was 3 months and the longest, 6 months). To determine whether treatment caused an effect on migraine frequency and severity, the baseline and posttreatment values were compared using nonparametric sign test.

Results Thirty-three MS subjects with PBA, who also suffered from migraines, were identified. Twenty-nine subjects had improvement in headache frequency, 4 had no change, and none had worsening (P < 0.001 as compared with the baseline). Twenty-eight subjects had improvement in headache severity, 5 had no change, and none had worsening (P < 0.001).

Conclusions Our pilot study results provide evidence that DMQ shows promise as a candidate for larger clinical studies evaluating its efficacy for the prevention of migraine headaches.

*Department of Neurology, Comprehensive Multiple Sclerosis Center, Keck School of Medicine of University of Southern California, Los Angeles, CA; †Valdman Institute of Pharmacology, Pavlov First State Medical University & Pavlov Institute of Physiology of the Russian Academy of Sciences, Saint Petersburg, Russia; ‡Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA; §Department of Neurology and Neurosurgery, Kazan State Medical University, Kazan, Russia; and ∥Department of Neurology, Headache Division, Keck School of Medicine of University of Southern California, Los Angeles, CA.

Address correspondence and reprint requests to Regina R. Berkovich, MD, PhD, Department of Neurology, Comprehensive Multiple Sclerosis Center, Keck School of Medicine of University of Southern California, 1520 San Pablo St, 3000, Los Angeles, CA 90033; E-mail: rberkovi@usc.edu, always cc: reginaberkovichmd@gmail.com

Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare.

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