It’s our favourite wonder drug again. I think some of you have seen this already but it’s an article MAVNY Lisa sent to me months back. Certainly some anecdotal evidence here that supports most people’s positive rating for Valium and Klonopin.
[size=150]Prophylactic Valium for Migraine[/size]
By: Kristina Fiore | June 04, 2010
My father is a migraineur. He’s always been, for as long as I can remember. Countless times as a little girl, I saw him lying on the couch, sleep mask on, a hand pressed over his forehead. His average: eight to 12 episodes a month.
Of course, there was little he could do to quell the pain in the early 1980s, aside from retreating to that familiar pose after a dose of over-the-counter painkiller. Sometimes an emergency department visit was necessary.
Over the years, many treatments evolved – both prophylactic and acute – and he tried them all. Tylenol with codeine didn’t help, nor did Midrin, a combination of isometheptene, dichloralphenazone, and acetaminophen. Preventive propranolol (Inderal) did nothing.
He stuck with prophylactic topiramate (Topamax) until it gave him kidney stones. His least favorite was probably preventive Lithium, which he gave up on rather quickly.
In the late 1990s, when injectable sumatriptan (Imitrex) came out, he was thrilled that it actually worked in the acute setting – although he wasn’t too keen on self-injection (aside from suffering through migraines, his threshold for pain is quite low. He was not a pleasant person to be around when he had those kidney stones, to say the least).
Finally, he was saved when the oral version of sumatriptan came to market – almost. Clearly, it would be much better if one of the preventive treatments worked instead.
But nothing did.
Until last December, when he went to the dentist. An injection-site reaction from some work he had done was causing him pain, so she prescribed him a 10-day course of diazepam (Valium).
Now, my father is a meticulous record-keeper. He still has data on every single migraine he’s had, every day, since the mid-90s when we got our first computer. That’s how he knows his average is eight to 12 episodes per month.
So he found it strange that over those 10 days, not a single cell in his migraine spreadsheet was marked with an attack.
He called his primary care physician. Sure, the doctor said, diazepam is a muscle relaxant, and his migraines could originate from tension. (Although my dad is certain that he doesn’t grind his teeth at night or have TMJ or any other condition that would be indicative of muscle tension.)
The physician said he wouldn’t go around prescribing it to everyone with migraine, but if my dad finally found something that works, he would recommend continuing the therapy.
This course of treatment was surprising to me (you can imagine the cautions I have about daily Valium), so I did a search of the literature. I found nothing on prophylactic diazepam for migraine.
I reached out to migraine experts. In an e-mail, Peter Goadsby, MD, of the University of California San Francisco, said diazepam is never used for prevention, that there’s “no evidence at all for its use,” and certainly no randomized controlled trials.
“There is some general view that it is unhelpful when used regularly,” he told me.
My dad has to disagree. Throughout that December, he had only one migraine – and it was around Christmas, which, of course, involves parties, cocktails, and a lack of sleep.
It’s been six months now since he’s been on the 5mg/day treatment, and his worst month involved just five migraines – less than half the norm. His average is only three per month – a reduction of about 75%.
Importantly, he’s had no side effects (but of course, we will be watching vigilantly for these).
The fact that this old drug can work so efficiently (and cheaply – my dad’s prescription costs just $3.80 a month) speaks to the heterogeneous nature of migraine. Certainly it won’t work for everyone. And I’m sure there won’t be any trials of prophylactic diazepam in migraine any time soon to determine what subpopulations may benefit most.
But it does say that the current approach to migraine treatment may be too general. Migraineurs are likely to be among the greatest beneficiaries of the upcoming era of personalized medicine.
Check out the comments here (some from MDs):