AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Gautam Anand, Professor and Head, Psychiatry I Medical College
Citation: Anand G, (2020) Role of flunarizine in treatment of headache in depression - Comparison to antidepressant used as prophylaxis of migraine and Emergence prevention of headache in depression. Neural Plasticity and Clinical Practice, 3(1): DOI: 10.31579/NPCP.2020/010
Copyright: © 2020. Gautam Anand. This is an open-access article distributed under the termsof the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 10 November 2019 | Accepted: 25 December 2019 | Published: 20 February 2020
Keywords: depression; flunarizine; bi- directional relationship; hyperserotonergic syndrome. SSRI, migraine
In our previous study of on depressive patient were shown appearance of pulstile headache as a most common type of headache mostly located on bilaterally on temporal region and hypothesized that it as an intermediate phenomenon. Depression itself, or may be due to social and cultural variation was identified as a psychiatric suffering that was not recognized as a illness hence thought as iceberg It is well evident that migraine and depression is interchangeable and has bidirectional relationship . Tension band like headache is earliest to be recognized but it remained poorly recognized possibly may be due more pain tolerance , depression itself has social and cultural variation. The drug used in the treatment of migraine and depression is little bit more comprehensible to understand. The use of propranolol and flunarizine has depressant properties in long term . Simultaneously the use of flunarizine with SSRIS warn induction of hyperserotonergic syndrome as FDA black box sign. Author has discrete opinion on use of flunarizine in treatment of headache in depression The area of interest with contradictory reports on use of flunarizine...We try to find out role of flunarizine in preventing appearance of depression and transformation of tension band headache, throbbing headache into migraine and finally into depression.
Flunrizine is effective in treatment as well as prophylactic in management of migraine. It is equally effective as pizotifen and long term use as cinarizine in vertigo. Some of the interesting findings related to its use are its effectively in induction of neo- vascularisation in cerebrovascular as well as peripheral vascular disease and improvement in cognitive function , but it never been compared to methylsergide . [1] The use of flunarizine is not free from side effect as other drugs . Since it is a calcium channel inhibitor and anti dopaminergic effect , it appears with side of anitneuroleptic drugs frequently with movement disorder , depression and drowsiness .[2 -3]
Clinical resemblance of chronic pain may variable etiologies . In case of traumatic brain injury will have highest onset of pain syndrome i.e. chronic headache [5]. Migraine and depression study has strong advocacy on bidirectional relationship of migraine, migraine predicting pre onset depression and depression predicting pre onset migraine. Chronic pain may have highest association with depression [6]. The explanation for their bidirectional relationship have common shared pathway. [7, 8] same relationship were found with panic disorder (9<. Other psychiatry condition may also found with migraine and chronic headache Panic disorder may be one of them [12] Others are various anxiety disorder such OCD and anxiety (10). Supressed anger and anger trait may also be seen in depression associated with headache [13].There are strong relationship between tebsion headache and several psychologic factors are found but the exact role and influence on evolution of headache is not known . migraine is more often seen with anxiety and depression [14]. The author also emphasized depression and various pattern of headache and how it affects daily living in indian subjects . He also expressed the out come with bidirectional relationship and protulate hypothesis which ways the treatment of headache in depression and learnt the methodology of treatment with rational use of flunarizine and antidepressant especially SSRI . The clinical use of the antidepressant signifies the relationship between headache and depression. Reduction of headache, pain reduces the depression which needs to further clarify. [11] The clinical use of migraine prohyaxis of flunarizine and SSRI Based on precedence to answer when and why use them in mono therapy or may be combination of both .
To evaluate role of flunarizine in treatment of depression and its ability to prevent or transform migraine into depression
Tools – HAMD rating scale and headache format of questionnaires
screened and selected patients who scored more than 9 on HAM-D scale and has complaints of headache irrespective of headache characters into three designed groups on the basis of three questions - which comes first headache or depression or unable to recall .Put them into three groups and treat them with frunarizine , sertaline and combination of both respectively for four weeks .The test applied to measure score of depression on Halminton depression rating scale and headache on arbitrarily design format for assessment of headache on three domains such as 1) headache itself , 2) severity of heache and 3) duration of headache in yes /no format .The two consecutive scores were taken one at time of visit as base line and another at the end of treatment at 4th week . The obtained data were analyzed and compared among groups and to other groups also
Group –A contains no of patients who answered depression came first and headache later to depression were treated with sertaline 50 mg /day at bed time
Group – B contains no of patients who answered headache came first and depression later to headache were treated with flunarizine 10 mg /day in morning in day hr.
Group –C contains no of patients who answered unable to tell which came first
were treated with sertaline 50 mg / day plus flunarizine 10 mg /day 12 hr apart.
Total selected patient who scored more than 9 on HAM-D scale and complaints of headache were 58 in number out which 22 were droped and rest 36 were continued in study till completion of 4 week . At start of study there were measured on HAM-D scale and headache assessment format at the end of treatment same were applied and in addition looked for treatment response of headache on three questions 1) remission of headache i 2) remission of severity of headache 3) remission of duration and frequency of headache.
Group A had 21 patients of mean age of 33.904 sd= 9.449.Among them 9 were male , 12 were female , 19 were Hindu and 2 were Muslim HAMD Score mean before and after treatment with SD of 22.76 SD=4.96 and 5.50 SD= 2.16, SEM before treatment = 1.108 . SEM after treatment =0.48 , CD = 19 ,CI=85% SE of difference of mean= 1.137 , t test score = 15.444 , P <0>
Fig -1 Socio demography
Group B had 12 patients of mean age of 31.5 04 SD= 9.496.Among them 2 were male 10 were female , 8 were Hindu and 4 were Muslim HAMD Score mean before and after treatment with SD of 20.82 sd=5.53 and 5.55 SD =2.49, SEM before treatment = 1.60 SEM after treatment =0.89 , CD = 15 ,CI=85% SE of difference of mean= 1.876 , t test score = 7.8968 , P <0>
Group C had 3 patients of mean age of 40 sd= 5.Among them there were no male 3 were female , 2 were Hindu and 1 were Muslim HAMD Score mean before and after treatment with SD of 23 SD=3.29 and 6 SD= 1.41, SEM before treatment = 3.06 , SEM after treatment =1 , CD = 17 ,CI=85% , SE of difference of mean =4014 , t test score = 4.2353, P =0.241 S ( significant) headache response 3y at the end of treatment .
FIG – 2 treatment response in group before and after tretment
Fig -3 HAMD score inall group after treatment
Comparison between GROUP A and GROUP B
CD = 0.0500, CI=95%, SE of difference of mean = 0.922, t test score = 0.0542, P =0.9571 NS (NOT significant) headache response had no difference in treatment response
Comparison between Group A and Group C
CD = 0.0500, CI=85%, SE of difference of mean = 1.334, t test score = 0.378, P =0.7114 NS (NOT significant) headache response had no difference in treatment response
Fig -4 graph representing change statistical parameter of treatment response
Comparison between GROUP B and GROUP C
CD = 0.4500 ,CI=95% , SE of difference of mean=1.882 , t test score = 0.2391 , P =0.8148 NS
(NOT significant) headache response had no difference in treatment response
Fig-5 represent headache response of tretment in Y/N format
Flunarizine has adverse effect of depression and movement disorder in elderly population and other group (1-4) inspire of that the common sharing nature of migraine and depression and its bidirectional relationship is the basis of treatment benefit with flunarizine (5-15). The treated group of 12 patients who had noticed emergence of headache before depressive symptoms had shown improvement of depressive symptoms as well as headache as extremely significant. Similarly those had depressive symptom preceding to somatic headache symptoms treated with sertaline also had the same results p<0>
Flunarizine can act as antidepressant in specific disease condition where headache and depression co exist and headache preceded depression Sertaline alone can be used in treatment of depression and headache ? Migraine.Those who fails to tell which occurs first can be benefited by combination of these two .It also proves the bidirectional relationship of migraine and depression.The significance of the question which occurs first headache or depression or unable to tell will design on the basis of existing problem facilitate immunotherapy and cost effective.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
