Flunarizine for Migraine Prevention

Efficacy and Recommendations

The American Academy of Neurology recommends flunarizine as a second-line treatment for migraine prevention, after beta-blockers, topiramato, and candesartan 1
Flunarizine has proven efficacy in preventing migraine attacks, with a recommended dose of 10 mg/day, and its benefits may take 2 to 3 months to manifest 2
The European Neurology Society suggests that flunarizine is an effective treatment for migraine prevention, with a significant reduction in attack frequency and severity 1

The American Headache Society recommends considering preventive treatment, including flunarizine, for patients with two or more migraine attacks per month that produce disability for 3 or more days per month 3
The treatment algorithm suggests using beta-blockers, topiramato, or candesartan as first-line treatments, followed by flunarizine as a second-line option 1

The recommended dose of flunarizine is 10 mg/day, administered preferably at night to minimize sedation 1
The clinical benefit of flunarizine may take 2 to 3 months to manifest, requiring an adequate treatment period 2

The most common adverse effects of flunarizine include sedation, weight gain, and abdominal pain 2
Depression and extrapyramidal symptoms may be observed, particularly in elderly patients 2

The American Academy of Family Medicine suggests initiating flunarizine when patients meet specific criteria, including two or more migraine attacks per month producing disability for three or more days, use of acute medications more than twice weekly, failure of or contraindications to acute treatments, or presence of uncommon migraine conditions, with a recommended first-line preventive medication trial before considering flunarizine 4
In patients with mixed migraine and tension-type headache, amitriptyline may be more effective than flunarizine, according to the American Academy of Family Medicine 4