flunarizine / Generic mfg. - LARVOL DELTA

Evaluating agreement between physician and ChatGPT in migraine prophylaxis selection: A pilot comparative study (EHF-EHC 2025) - "To evaluate the level of agreement between human clinicians and an artificial intelligence (AI) model (ChatGPT) in recommending first-line prophylactic therapies for patients with migraine, and to assess the potential clinical value of AI-generated support.In this observational pilot study, we analyzed 21 consecutive patients with a confirmed diagnosis of episodic migraine evaluated at a pain clinic.For each patient, the treating clinician selected a first-line preventive treatment among four options: amitriptyline, propranolol, topiramate or flunarizine. This pilot study demonstrates that ChatGPT can produce clinically coherent prophylactic treatment proposals in the management of migraine, with a statistically significant moderate agreement with experienced pain physicians. Further validation on larger cohorts is warranted to explore its potential as a clinical decision support tool."

CNS Disorders • Migraine • Pain

Improvement in headache frequency does not alter pain sensitivity in chronic migraine treated with flunarizine (EHF-EHC 2025) - "These findings align with our previous EEG results, demonstrating persistent abnormal occipital power despite clinical improvement. The dissociation between improved headache profiles and alterations in pain sensitivity deserves further investigation, whether altered pain threshold in migraine is an intrinsic character rather than a symptom of migraine."

CNS Disorders • Immunology • Migraine • Pain

Comparative efficacy and safety of topiramate versus flunarizine in migraine prophylaxis: A systematic review and meta-analysis (EHF-EHC 2025) - "Safety profiles were broadly similar, except that the topiramate group demonstrated higher incidences of paresthesia. Future RCTs should include larger sample sizes and use standardized reporting frameworks, including a core outcome set, to ensure consistency across studies and allow for more definitive and generalizable conclusions."

Retrospective data • Review • CNS Disorders • Migraine • Pain

Primary cough headache – Botulinum toxin protocol treatment with a new indication? (EHF-EHC 2025) - "Indomethacin is the first-line treatment, but alternatives like acetazolamide or cerebrospinal fluid drainage have shown benefit in refractory or contraindicated cases...Initial treatment with flunarizine was ineffective...Trials with amitriptyline and propranolol were unsuccessful. A PREEMPT protocol with botulinum toxin was initiated, resulting in a reduction in headache frequency to 15 days/month after the first cycle, and fewer than 5/month after the second, with sustained improvement. Botulinum toxin is a safe and effective therapeutic option for PCH, especially in patients unresponsive to or intolerant of standard pharmacological treatments."

Clinical • Cardiovascular • CNS Disorders • Cough • Gastroenterology • Hypertension • Migraine • Otorhinolaryngology • Pain • Rare Diseases • Renal Disease • Respiratory Diseases • Sleep Disorder • Vertigo

Assessing the effectiveness of personalized migraine treatment – A 22-year N-of-1 study (EHF-EHC 2025) - "No significant adverse effects were reported Topiramate (2006) was ineffective (+8.3% headache days); amitriptyline (2008) increased headache days (+20.4%) but reduced zolmitriptan use (−37.7%)...Erenumab (2020–2021) worsened both metrics (+4.1%, +37.8%). Flunarizine (2023) had modest benefit (−17%), and oxitriptan (2023–2024) had minimal effect. Despite long-term triptan overuse, the patient never developed medication-overuse headache, and zolmitriptan remained effective throughout We report a case of chronic refractory migraine with long-term triptan overuse but without evidence of medication-overuse headache. This case raises the question of whether pharmacological resistance to preventives may be linked to preserved responsiveness to acute treatments"

CNS Disorders • Migraine • Mood Disorders • Obsessive-Compulsive Disorder • Pain • Personality Disorder

Middle meningeal artery lidocaine infusion for refractory migraine: First case report in Portugal (EHF-EHC 2025) - "Various pharmacologic classes were tried without benefit: antihypertensives and calcium channel blockers (propranolol, candesartan, flunarizine), antiepileptics (valproic acid, topiramate, oxcarbazepine), antidepressants (amitriptyline, nortriptyline, venlafaxine, fluvoxamine, sertraline, clomipramine), other preventives (prednisolone, oxitriptan, melatonin), cycles of botulinum toxin (PREEMPT protocol), monoclonal antibodies (galcanezumab, fremanezumab, erenumab), and atogepant. At the time of the procedure, the patient was on eptinezumab 100 mg and botulinum toxin every three months but continued to have daily headaches, with severe intensity and reliance on eletriptan for acute relief...It constitutes an invasive therapeutic approach that should be considered only as a rescue option for carefully selected patients with severely refractory migraine. Further studies and long-term follow-up are needed to assess efficacy and safety."

Case report • Clinical • Anorexia • CNS Disorders • Migraine • Pain

Acupuncture in migraine prevention: High-quality evidence from double-dummy randomized controlled trials and its implications in clinical practice (EHF-EHC 2025) - "(2011, n=140) compared acupuncture with flunarizine and found higher ≥50% responder rates (56% vs. 37% at 16 weeks), and greater reductions in migraine days (−4.1 vs. −2.0 at week 16)...(2024, n=60) compared acupuncture with topiramate, reporting larger reductions in monthly migraine days (−5.6 vs. -2.8 at 12 weeks), higher ≥50% responder rates (33.3% vs. 6.7%), and fewer adverse events (10% vs. 26.7%). Limited high-quality double-dummy RCTs indicate that acupuncture is an effective and well-tolerated preventive therapy, demonstrating efficacy comparable to or superior to pharmacological treatments with fewer adverse effects. Large-scale, multicentre double-dummy trials remain essential to generate robust evidence to strengthen physicians' confidence in adopting acupuncture as a viable option for migraine management."

Clinical • CNS Disorders • Migraine • Pain

Do we still need non-specific oral prophylaxis for migraine treatment in CGRP-era? Real-life results from an Italian tertiary headache center (EHF-EHC 2025) - "Of the remaining, 354 (56%) received anti-CGRP agents and/or onabotulinumtoxinA injectios; 16 (2.5%) preferred a non-Pharmacological Treatment, and 99 (15.7%) did not need preventive prescription. Among those receiving oral prevention, the drug offered was: tricyclic antidepressants in 52 (31.9%) patients, Beta-blockers in 36 (22.1%), anticonvulsants in 19 (11.7%), Calcium Channel Blockers (flunarizine) in 26 (15.9%), SNRIs in 14 (8.6%), ACEIs/ARBs (candesartan) in 10 (3.7%) and combination of two drugs in 6 (3.7%)...The most frequently prescribed treatments were antidepressants and Beta-blockers. In light of these observations, even in CGRP era, we suggest still an important role of oral conventional prophylaxis in the Headache Center setting."

Clinical • CNS Disorders • Migraine • Pain

Unraveling Alternating Hemiplegia of Childhood: A Case Report with Genetic and Clinical Insights. (PubMed, Case Rep Neurol) - "Management includes symptomatic treatment and supportive care, with flunarizine offering some benefit. This case highlights the need for early recognition and genetic confirmation of AHC to initiate therapy and improve quality of life."

Journal • CNS Disorders

Impact of Qihuang needle therapy combined with flunarizine hydrochloride for vertigo in vestibular migraine. (PubMed, Neurosciences (Riyadh)) - "This study suggested that QHN combined with FH might had a potential advantage in improving treatment outcomes and reducing short-term recurrence of vertigo in VM patients."

Journal • CNS Disorders • Migraine • Otorhinolaryngology • Pain • Vertigo

Anti-prion drugs reduce endoplasmic reticulum stress and protect human dopaminergic neurons from death. (PubMed, Biomed Pharmacother) - "Notably, several compounds - benzydamine, duloxetine, flunarizine, metixene and triflupromazine - protected LUHMES cells from MPP+ -induced ER stress at nanomolar concentrations. These findings provide the proof of concept that drugs selected for other indications, may be repurposed to ameliorate PD and related pathologies linked to ER stress."

Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

Persistent postural-perceptual dizziness versus vestibular migraine: A narrative review. (PubMed, Headache) - "A multidisciplinary approach addressing both conditions is critical for optimal patient outcomes. Studies on comorbid migraine treatment in patients with PPPD are warranted and may reveal distinct phenotypes within the same disease spectrum."

Journal • Review • CNS Disorders • Migraine • Otorhinolaryngology • Pain • Vertigo

MULTIFACTORIAL ANEMIA IN END-STAGE LIVER DISEASE: A CASE OF ZIEVE SYNDROME AND SPUR CELL ANEMIA (CHEST 2025) - "He developed hepatic encephalopathy, requiring daily Rifaximin and Lactulose...Despite aggressive management with vasopressors, steroids, dobutamine, continuous veno-venous hemofiltration, and bicarbonate infusion, his condition deteriorated...Alternative treatments, including flunarizine, pentoxifylline, and cholestyramine, have shown success in maintaining remission. This case highlights the rapid decompensation in ESLD and the importance of early recognition of conditions like Zieve Syndrome and Spur Cell Anemia. A comprehensive approach, including timely intervention and consideration for liver transplantation, is essential for improving patient outcomes."

Clinical • Acute Respiratory Distress Syndrome • Addiction (Opioid and Alcohol) • Anemia • Cardiovascular • CNS Disorders • Cognitive Disorders • Dyslipidemia • Fibrosis • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis • Pneumonia • Portal Hypertension • Pulmonary Disease • Respiratory Diseases • Septic Shock • HP

The nosology of tardive parkinsonism. (PubMed, J Clin Neurosci) - "This proposal has been based on the persistence without progression of a parkinsonian syndrome five years on average following discontinuation of cinnarizine and flunarizine in most of our case series of elderly patients. Whether a permanent non-progressive parkinsonism may occur in elderly patients also following discontinuation of other dopamine receptor antagonists as antipsychotics and benzamide derivatives remains to be established due to lack of comparable prospective follow-up studies. The recognition of TP in elderly patients is important since it has a more favourable long-term prognosis than Parkinson's disease."

Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

Two Cases of SCN4A Temperature-Sensitive Sodium Channelopathy: From Dystonia to Myotonia (MDS Congress 2025) - "Flunarizine provided no benefit, while levodopa showed initial efficacy that diminished over time... These cases highlight the potential misclassification of myotonic channelopathies as expressions of dystonia. The G1306A variant in SCN4A likely creates temperature-sensitive alterations in channel permeability, where exercise-induced metabolic changes and increased body temperature modify channel activity. This pathophysiological mechanism explains the exercise-triggered symptoms and has important therapeutic implications, as treatments for channelopathies differ from those for dystonia."

Clinical • CNS Disorders • Dystonia • Epilepsy • Movement Disorders • NAV1

Phenotypic Spectrum of Movement Disorders in TBC1D24 Gene Variants: A Case Series (MDS Congress 2025) - "2 patients with AHC were started on flunarizine, where 1 had no symptom improvement and adverse effects (musculoskeletal pain, increased tremor) and 1 refused the medication. Patient with focal-segmental myoclonus and epilepsy trialed levetiracetam, valproic acid and clobazam with complete seizure control, and clonazepam was added with moderately improved myoclonus. Patient with PED, PEA and epilepsy trialed levetiracetam, carbamazepine, and oxcarbazepine which worsened symptoms, so acetazolamide was started with significant improvement in symptoms and seizures... This study describes the phenotypic spectrum of movement disorders in 5 pediatric patients with TBCID24 variants. Identified disorders were diverse with varied treatment efficacy. Our findings expand disease understanding and suggest further research need on such emerging variants."

Clinical • Ataxia • CNS Disorders • Epilepsy • Movement Disorders • Musculoskeletal Pain

Drug-induced Parkinsonism Mimicking Parkinson´s Disease in Patients Treated with Flunarizine for Migraine (MDS Congress 2025) - "He was then prescribed with levodopa-carbidopa 125mg...Case 2: 68-year-old female, was prescribed with propranolol 20mg and flunarizine 10mg from our clinic for her frequent migraine episodes and was asked for follow-up in 3 months...Flunarizine was changed to dosulepin 25mg and followed in 2 months with minimal bradykinesia and mask face and resolved tremor. We should be cautious prescribing Flunarizine in elderly people, low-dose treatment, needed proper counselling beforehand regarding the likelyhood of motor adverse effects and regular monitoring of symptoms is needed. Early diagnosis cause reversal of symptoms and reduce the disease and economic burden of patients."

Clinical • CNS Disorders • Migraine • Movement Disorders • Pain • Parkinson's Disease

Expanding the Phenotypic Spectrum of CACNA1A Variants: A Single-Center Experience (MDS Congress 2025) - "Ataxia was treated in 2 patients with acetazolamide and flunarizine, with a partial response. CACNA1A variants show diverse phenotypes, predominantly with movement symptoms. Treatment response varies, highlighting the need for larger studies to better characterize phenotypes and explore treatment options"

Clinical • Ataxia • CNS Disorders • Dystonia • Epilepsy • Migraine • Movement Disorders • Parkinson's Disease • CACNA1A

Efficacy analysis of anti-migraine therapy for acute low-frequency hearing loss and investigation of its mechanisms (PubMed, Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi) - "The standardized group received oral/intravenous steroids + oral/intravenous Ginkgo biloba extract, while the anti-migraine group received postauricular steroid injection/oral steroids + oral flunarizine for 2 weeks...Among the anti-migraine group, 6 patients（21.43%） had a history of ALHL, 13（46.43%） had a confirmed migraine history, 26（92.86%） had anxiety, 26（92.86%） had depression, 5（17.86%） had irritable bowel syndrome, 21（75.00%） had sleep disorders, and 1（3.57%） experienced recurrence within 6 months. Anti-migraine therapy significantly improves the recovery rate in ALHL patients, suggesting that migraine may have a certain correlation with the pathogenesis of acute low-frequency hearing loss."

Clinical • Journal • CNS Disorders • Depression • Gastrointestinal Disorder • Migraine • Mood Disorders • Otorhinolaryngology • Pain • Psychiatry • Sleep Disorder

PERSISTENT VERTIGO SECONDARY TO A GJB2 GENE ALTERATION (WCN 2025) - "This case may suggest that some alterations in the GJB2 gene may manifest as persistent vertigo in patients with typical symptoms of sensorineural hearing loss and skin changes."

CNS Disorders • Vertigo • GJB2

THERAPEUTIC EFFECT OF FLUNARIZINE AGAINST STREPTOZOTOCIN INDUCED ALZHEIMER'S DISEASE (WCN 2025) - "The rats were divided into 6 groups: sham, diseased, FLN 10mg/kg, FLN 20mg/kg, FLN 40mg/kg and standard (donepezil 1mg/kg). The present study demonstrated that treatment with FLN showed a neuroprotective effect against Alzheimer's disease by targets the numerous pathologies that worsen the disease condition."

Alzheimer's Disease • CNS Disorders

Migraine with brainstem aura with abnormal EEG discharges easily misdiagnosed as epilepsy: a case series study. (PubMed, Ther Adv Neurol Disord) - "Following flunarizine administration, all three patients demonstrated improvement, with no subsequent occurrences of loss of consciousness during the follow-up period...Recognizing this specific condition constitutes a crucial element in the differential diagnosis of epilepsy, with the aim of preventing misdiagnosis. Concurrently, we investigate their pathophysiological origins."

Journal • Ataxia • CNS Disorders • Epilepsy • Migraine • Movement Disorders • Otorhinolaryngology • Pain • Vertigo

Ketogenic diet for alternating hemiplegia of childhood: Case report and literature review. (PubMed, Medicine (Baltimore)) - "Our case reinforces the role of the ketogenic diet as a novel therapeutic option for AHC. However, further specific confirmatory tests are necessary."

Journal • Review • CNS Disorders • Dystonia • Epilepsy • Movement Disorders • Pulmonary Disease

CACNA1A-associated epileptic encephalopathy triggered by minor trauma: importance of early diagnosis and appropriate treatment. (PubMed, BMJ Case Rep) - "The child was subsequently started on targeted therapy with flunarizine, acetazolamide and antiepileptic medications, which led to effective seizure control and neurological improvement. This case emphasises the need to consider CACNA1A-associated encephalopathy in children presenting with post-traumatic seizures and encephalopathy, as early diagnosis facilitates individualised treatment and may alter disease trajectory."

Journal • Cardiovascular • Cerebral Palsy • CNS Disorders • Epilepsy • Ischemic stroke • Mood Disorders • Movement Disorders • Parkinson's Disease • CACNA1A

Traditional Chinese medicine versus flunarizine for the preventive treatment of episodic migraine: a randomized controlled clinical trial. (PubMed, QJM) - "Of 343 patients screened, with 212 (mean age, 46.1 [SD 8.9] years; 162 [76.4%] female) were included in the intention-to-treat analyses. Baseline characteristics were cpmparable between groups. The TCM group demonstrated a significantly greater reduction in MMDs than the flunarizine group during both weeks 1-4 and weeks 5-16, with a difference of -0.64 days (95% CI: -1.07 to -0.20; P = 0.004) during weeks 1-4. and -1.13 days (95% CI: -1.48 to -0.78; P < 0.001) during weeks 5-16. These findings indicate that TCM is effective in preventing episodic migraine, with superior efficacy to flunarizine after 4 weeks of treatment, and sustained benefits for 16 weeks. TCM may therefore be considered an optional preventive therapy for episodic migraine without aura. These results support its use in patients unwilling to take, or unresponsive to, prophylactic drugs, and suggest its consideration in future clinical guidelines."

Clinical • Journal • CNS Disorders • Migraine • Pain