Dextromethorphan/Quinidine May Relieve Migraine in MS Patients With PBA
Pseudobulbar affect, which usually presents with episodes of uncontrollable crying and/or laughing, is a classic complication of multiple sclerosis.
Dextromethorphan/quinidine (DMQ) is a promising treatment option for migraines in individuals with multiple sclerosis and superimposed pseudobulbar affect, according to research published in Clinical Neuropharmacology.
This open-label observational clinical study enrolled 33 individuals with definitive diagnoses of multiple sclerosis and pseudobulbar affect who also experienced migraines. Since dextromethorphan/quinidine is primarily intended to manage symptoms of pseudobulbar affect, researchers used a nonparametric sign test to compare baseline data with data after treatment to determine efficacy of dextromethorphan/quinidine in treating migraines.
Twenty-nine of the 33 participants demonstrated reduction in frequency of headache, 4 experienced no change, and 0 showed worsened effects (P <.001). Twenty-eight showed reduction in headache severity, 5 experienced no change, and 0 showed worsened effects (P <0.001). The medication was also well tolerated and reduced the need for abortive migraine medications.
The study was performed at the Comprehensive MS Center at the University of Southern California. Researchers included patient migraine medication usage as well as the frequency and acuteness of migraines in baseline characteristics. They administered dextromethorphan/quinidine 20 mg/10 mg orally two times per day for a mean of 4.5 months, with time of exposure ranging from 3 to 6 months.
Current therapy options for migraine are limited and leave many patients untreated. Other medications are prescribed for conditions that are regular migraine comorbidities and testing them for efficacy in treating migraine is a promising option, as it has proved successful in the past.
Researchers conclude that “[dextromethorphan/quinidine shows promise as a candidate for larger clinical studies evaluating its efficacy for the prevention of migraine headaches.”
Berkovich RR, Sokolov AY, Togasaki DM, Yakupova AA, Cesar PH, Sahai-Srivastava S. Dextromethorphan/quinidine in migraine prophylaxis: an open-label observational clinical study. Clin Neuropharmacol. 2018;41(2):64-69.