{"id":939,"date":"2016-01-06T16:11:01","date_gmt":"2016-01-06T16:11:01","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=939"},"modified":"2017-08-21T11:14:14","modified_gmt":"2017-08-21T11:14:14","slug":"primary-care-corner-with-geoffrey-modest-md-migraine-prophylaxis-with-simvastatinvitamin-d","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/01\/06\/primary-care-corner-with-geoffrey-modest-md-migraine-prophylaxis-with-simvastatinvitamin-d\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Migraine Prophylaxis with Simvastatin\/Vitamin D"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/p>\n<p><\/strong><\/p>\n<p style=\"text-align: left\">A small research study found that using the combo of simvastatin 20mg plus vitamin D3 1000 IU bid led to decreased migraine recurrences (see\u00a0Ann\u00a0Neurol\u00a02015;78:970\u200b). The basis for this study was that the\u00a0usual treatments (anticonvulsants, b-blockers, tricyclics) often have problematic adverse effects, and that migraines may involve a component of endothelial dysfunction\/vascular\u00a0inflammation\u00a0which may improve with a statin and vitamin D.<\/p>\n<p>Details:<img loading=\"lazy\" decoding=\"async\" class=\"wp-image-940 alignright\" src=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2016\/01\/headace.jpg\" alt=\"headace\" width=\"299\" height=\"199\" \/><\/p>\n<ul>\n<li>57 patients with migraine diagnosis and at least 4 migraine-days\/month were randomized\u00a0(mean age 40 in active treatment\/28 in placebo!!; 90% women; 4% current smoker; 40% with seasonal allergies; 40% anxiety\/depression; 50% on\u00a0oral contraceptives; 50% on current migraine prevention meds). \u00a0Most had migraines\u00a0&gt;10 years and had tried median of 3 abortive agents in the past.\u00a0Note that in this small study, many of these %&#8217;s\u00a0differed from the active med vs placebo groups (e.g.,\u00a0number of migraine days was 25.5 in the past 3 months in the active med group but only 18 in the placebo group). Those on migraine prophylactic agents continued taking them.\u00a0Followed 24 weeks<\/li>\n<li>Primary outcome: change in number of days with migraine; secondary outcome: changes in use of acute migraine meds, and migraine disability\/duration\/intensity\/associated symptoms<\/li>\n<\/ul>\n<p>Results:<\/p>\n<ul>\n<li>\u200bPrimary outcome: those on\u00a0active treatment in the first 12 weeks\u00a0had a decrease of 8 migraine-days (-15.0 to -2.0) vs +1.0 in the placebo group (-1.0 to +6.0), with p&lt;0.001. During the second 12 weeks, there were similar improvements: -9.0 days with active treatment (-13 to -5) vs +3.0 with placebo (+1.0 to +5.0) with p&lt;0.001. And, 29% of those on active meds had &gt;50% reduction in migraine-days\u00a0vs 3% on placebo<\/li>\n<li>Secondary outcomes: those on active meds: used fewer abortive migraine meds, and had\u00a0both fewer days of meds (p&lt;0.001)and fewer doses of meds\u00a0(p&lt;0.001); less migraine disability (p&lt;0.001); but no difference in symptoms when migraines did occur, nor of migraine severity\/duration\/symptoms<\/li>\n<li>There were similar reductions in migraine in those continuing with their other prophylactic meds or not<\/li>\n<li>\u200bRegression analysis showed no difference in response by baseline values, including age and BMI, or if baseline &lt; vs &gt;8 migraine-days\/month<\/li>\n<li>Adverse events: very few, nonsignficant differences (though interesting that there were more myalgias in the placebo group as well\u00a0as joint\/skeletal pain)<\/li>\n<\/ul>\n<p>So, a few points:<\/p>\n<ul>\n<li>The magnitude of this treatment effect (30% fewer migraine-days) exceeds that of many of the other drugs currently\u00a0used clinically\u00a0(though\u00a0actually hard to compare the studies since different study designs)<\/li>\n<li>The simvastatin\/vitamin D\u00a0was\u00a0really well-tolerated, vs the reported 25-50% range discontinuance rates reported for amitryptaline, topiramate, and propranolol.<\/li>\n<li>Clearly this was a small and preliminary study. But the results were pretty impressive, for meds that are used all the time\u200b for other indications, are\u00a0well-tolerated, and may even have other benefits (vitamin D and bone\/?immunologic function; statins and atherosclerosis prevention). Though a bigger study is necessary to confirm the above, I think it is reasonable to try simvastatin\/vitamin D in patients with frequent migraine with either minimal response or too many adverse effects of the standard prophylactic meds (and I wonder if combos of this with other meds might be even more effective, since they likely have different\u00a0mechanisms of action).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Migraine Prophylaxis with Simvastatin\/Vitamin D [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/01\/06\/primary-care-corner-with-geoffrey-modest-md-migraine-prophylaxis-with-simvastatinvitamin-d\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-939","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/939","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=939"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/939\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=939"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=939"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=939"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}