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Pizotifen, better known by its brand name, Sandomigran®, is a medication used to help prevent vascular headaches such as cluster or migraine headaches. It is used as a preventative measure, but is not considered sufficient as a treatment once pain has already begun. This medication is generally thought to be effective, but is usually prescribed as a last resort because it is known to cause several side effects. Pizotifen is widely used throughout Canada and Europe.
Certain types of headaches, such as migraines, are associated with the widening of blood vessels in the brain. At the start of a migraine attack, it is thought that serotonin is released, causing blood vessels to narrow. Other chemicals are also released that can cause the blood vessels to expand. Pizotifen works by blocking serotonin receptors within the brain, which in turn is said to stop blood vessels from rapidly widening and narrowing. In addition, it is thought to block histamine receptors, which may also cause a widening of blood vessels, as well as inflammation.
Pizotifen is chemically similar to many antidepressants in structure and action, and it is thought that it may be similar in effect. In animal testing, this drug exhibited a mild sedative quality, which was thought to be beneficial in treating mild to moderate depression and anxiety. Other animal testing has shown that this medication may be effective in treating an overdose of the drug known as Ecstasy, or 3,4-Methylenedioxymethamphetamine (MDMA).
In many cases, a doctor may initially prescribe a low dose of this medication, then gradually increase the dosage until it becomes effective. To help lessen side effects, many doctors will try to prescribe the lowest dose that will provide the best results. Over time, a doctor may dispense lower doses to see if taking this drug is still necessary.
The most common side effects associated with taking pizotifen are drowsiness, increased appetite, and weight gain. These are thought to be temporary, and may subside over time. There are also several other side effects that are considered less common. These may include confusion or nervousness, weakness, dry mouth, and fluid retention.
This drug may also interact negatively with other medications. Antidepressants, antihistamines, and sleeping pills may cause further drowsiness. Alcohol, as well as heart and diabetes medications, may interact with this medication as well. In addition, natural remedies such as St. John's wort may lower the effectiveness of pizotifen.
@ElizaBennett - I had a round of those a few years ago, so you and your husband have my sympathy. They also call them "suicide headaches" and I'm sure you can see why!
For me, I had gone to an urgent care center on the weekend and had just been given the acute headache medicine. Later, I made an appointment with a neurologist who specialized in headaches, and he put me on verapamil, which is a calcium channel blocker. (Incidentally, he was the best doctor I've ever seen. He came to the waiting room personally to get me, did all the history and exam himself, really made me comfortable.)
Pizotifen is not the first choice migraine or cluster treatment
because of the side effects, which are pretty common. For a cluster headache, I think they usually try a calcium channel blocker first because most people will find that it is effective and has few or no side effects. (That was my experience.) The doctor I saw said his next treatment would be prednisone, which also has some serious side effects, but thankfully we never got that far.
My husband was recently diagnosed with cluster headaches. So far, he has only been prescribed medicine to stop the headaches once they've started. Not good enough! For one thing, the nasal spray headache relief they prescribed is incredibly expensive, and for another, sometimes he gets them at night.
By the time they wake him up (yes, they're that painful - that's one reason why they call them "alarm clock headaches), they're so far along that the medicine doesn't always help.
So I think he needs a control medicine. Should he ask for pizotifen? Or something else?