Clinical trial of methysergide and other preparations in the management of migraine

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Abstract
A study of the clinical use of methysergide, a serotonin antagonist, in 320 migraine patients is presented. Sixty three of these (20%) became virtually headache free and of these in 36 cases a 6 mg daily dose was required, while in 27 cases the dosage was reduced to 4 mg. daily. Substantial improvement was shown in 117 patients, no change in 97, and 43 cases were abandoned due to side-effects and relapses. The most frequent and most troublesome side-effects of methysergide are those presumably caused by vasoconstriction such as limb pains, swelling of ankles, angina pectoris and facial flushing. Other side effects included gastro-intestinal distrubances, skin rash, scalp hair falling out, vertigo and ataxia. Males responded better to the drug than females and patients 21-40 years of age fared worse than average. The mode of action of methysergide in unknown at present. The observations suggest that methysergide is either reducing the degree of vascular dilatation to a point where it is no longer painful or peripherally blocking the action of some pain-producing substance.