Role of memantine in the prophylactic treatment of episodic migraine: A systematic review

• Published in: Headache Vol. 61; no. 8; pp. 1207 - 1213
• Main Authors: Mistry, Vinita M., Morizio, Paige L., Pepin, Marc J., Bryan, William E., Brown, Jamie N.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-09-2021
• Subjects: Case reports; chronic migraine; Clinical trials; Dementia disorders; Disease prevention; Disorders; Evaluation; Excitatory Amino Acid Antagonists - adverse effects; Excitatory Amino Acid Antagonists - pharmacology; Headache; Headaches; Health care; Health services; Humans; Memantine; Memantine - adverse effects; Memantine - pharmacology; Migraine; migraine disorders; Migraine Disorders - drug therapy; Nausea; N‐methyl‐d‐aspartate receptor antagonist; Outcome Assessment, Health Care; Patients; prevention; Prophylaxis; Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors; Side effects; Systematic review; N-methyl-d-aspartate receptor antagonist; headache; chronic migraine; memantine; prevention; migraine disorders
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/head.14186

Objective
The purpose of this systematic review is to assess the efficacy and safety of memantine for the prophylactic treatment of episodic migraine.
Background
Migraine is a prevalent chronic disease with significant costs to the health care system. Although various prophylactic treatment options are available, these medications have limitations based on efficacy, potential side effects, and patient preference. Memantine is an N‐methyl‐d‐aspartate receptor antagonist used in dementia treatment that may have potential benefit for migraine prophylaxis.
Methods
A systematic search of PubMed, Embase, and CENTRAL databases was conducted to identify relevant published studies through December 2020 using the search terms: migraine disorders, migraine, headache disorders, or headache and memantine. Studies selected for the systematic review included prospective, interventional designs and evaluated memantine for prophylaxis of migraine. Animal studies, case reports, s, review articles, protocols without results, and studies not written in English were excluded. Data were extracted using a standardized systematic process and included author, publication date, study design, sample size, patient characteristics, treatment regimen, clinical efficacy outcomes, and adverse drug effects.
Results
Four articles were identified for inclusion representing two prospective open‐label studies and two randomized, double‐blind trials, evaluating 183 patients on memantine overall. A reduction in number of migraine days and headache severity were shown in all four studies in the participants treated with memantine. The most common adverse effects included somnolence, sedation, and nausea, none of which were severe.
Conclusion
The studies in this review establish that memantine has the potential for use as a treatment option for episodic migraine. Additional long‐term studies using an active comparator would be useful to further elucidate its role.