Propranolol and femoxetine, a 5 HT-uptake inhibitor, in migraine prophylaxis

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Abstract
The prophylactic effect of 5-HT [5-hydroxytryptamine] uptake inhibitor femoxetine was compared with propranolol (Frekven) in a double-blind crossover trial of 6 mo. duration in 49 patients. Twelve patients withdrew because of drug failure or failure to attend checkups (6), side effects (4) or other non-drug related causes (2). In the 37 patients who completed the trial there was no significant difference between propranolol 160 mg and femoxetine 400 mg with respect to the number of headache days or the number of migraine attacks during the last 2 mo. of each treatment. Propranolol was superior to femoxetine when the headache index was used. Partial depletion of thrombocyte 5-HT by a 5-HT uptake inhibitor does not lead to a marked improvement in all patients contrary to what might be expected from the 5-HT hypothesis of migraine. Due to the infrequent subjective side effects associated with femoxetine treatment, it may be a valuable prophylactic drug to a subgroup of migraine patients.