Muscle relaxants for migraines

Muscle relaxants can be surprisingly effective for the prophylactic treatment of migraine headaches. It is surprising because migraine is a brain disorder and not a disorder of muscles. However, studies have shown that during a migraine attack muscles are in fact very contracted and that is probably why people find some relief by rubbing their temples and the back of the head. We also thought that Botox works by relaxing these tight muscles, but it turned out that it also works on nerve endings. Muscle relaxants also do more than just relax muscles – they actually work on brain mechanisms of migraines. Not all muscle relaxants help migraines and the most evidence exists for tizanindine (Zanaflex). A double-blind study was done by Dr. Alvin Lake and his colleagues and it showed very good efficacy and few side effects. The target dose was 8 mg three times a day, but the average dose was 18 mg a day. The main side effect of this drug is sedation, but otherwise it is fairly benign. Baclofen (Lioresal) is another muscle relaxant that has been subjected to a double-blind study and was found to be effective for the prevention of migraine headaches. The drug was also given three times a day with a total dose ranging from 15 to 40 mg a day. The main side effect of baclofen is also sedation. Other muscle relaxants, such as metaxalone (Skelaxin), cyclobenzaprine (Flexeril), clonazepam (Klonopin), and other have helped some patients, but there are no scientific studies to prove their efficacy in migraine.

2 comments
  1. Bill says: 11/14/20125:43 pm

    I was wondering if there is much evidence for use of tizanindine for chronic daily headache that is far more of the tension-type than classic migraine? I have a diagnosis of New Persistent Daily Headache, a form of chronic daily headache, that has proved refractory to elavil, topomax, depokate, three rounds of botox, IV-DHE, and occipital nerve blocks, and physiotherapy. Characterized by vice-like pain and great tenderness on palpitation bi-laterally over the course of the occiptial nerves, it is unremitting. My neurologist wants me to start on sibelium but, wary of the side effects, I might ask him to prescribe tizanindine instead.

    Great blog, Dr Mauskop.

    Best

    Bill

  2. Dr. Mauskop says: 11/14/20126:57 pm

    Yes, there is a very good scientific (double-blind, placebo-controlled) study of tizanidine for chronic migraines. It was fairly large, involving 200 patients and it showed that tizanidine is clearly better than placebo in relieving chronic migraines. You can direct your neurologist to the article that describes this study.

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