Efficacy Of Nicergoline Combined With Flunarizine In The Treatment Of Migraine And Its Effect On PAGM And MCA-MV

Objective:To investigate the efficacy and adverse drug reaction(ADR)of nicergoline combined with flunarizine on migraine,it’s effect on MCA-MV and PAGM.Objects and methods:Migraine suffers were selected,including outpatient or in-patient in the department of neurology,our hospital,between February2018 to August 2019.At the time of reception,migraine patients were specifically asked the days of migraine attack and the lasting time of headache within 4 weeks prior to hospitalization,and visual analogue scale(VAS)was used to assess the pain degree.In this study,60 patients were selected as the research object,they were willing to participate in clinical trials and evaluated were eligible,then they were divided into combined medication and monotherapy medication group,and 30 cases each group,according to the odd or even number at the end of the outpatient number or the inpatient number.The average cerebral blood flow velocity(MCA-MV)was measured by transcranial doppler ultrasound(TCD),and the maximum platelet aggregation rate(PAGM)was measured using a PL-12 platelet function analyzer(PAGM testing was performed via diphosphate Adenosine(ADP)and arachidonic acid(AA)induction).Another 30 health examinees who were matched with the age,gender of migraine patients and whose physical examination contents included PAGM and MCA-MV were selected as the control group.The enrolled migraineurs underwent four weeks of treatment with different regimens.The combination group(nicergoline tablets 10mg tid pron.+flunarizine hydrochloride drop pills 10mg qd pron.),the monotherapy group(flunarizine hydrochloride drop pills 10 mg qd pron.),each migraine patient had a migraine diary(including the date of migraine pain,lasting time of pain,degree of pain,and adverse reactions during medication).At the end of the treatment,the above indicators were counted and the MCA-MV,ADP-PAGM,AA-PAGM were reviewed.The primary outcome measures were measured by the proportion of respondents(defined as a reduction of at least 50%in migraine days);secondary outcome measures including the days of migraine and the lasting time of pain,VAS,ADP-PAGM,AA-PAGM and MCA-MV.Then they were compared and statistically analyzed with SPSS25.0 software.Results:1.ADP-PAGM,AA-PAGM and MCA-MV in the combination group and the monotherapy group were significantly higher than those in the healthy examinees before treatment,the difference is statistically significant(P<0.05).2.The days of migraine,lasting time of pain,VAS,ADP-PAGM,AA-PAGM and MCA-MV,before and after treatment in the combined treatment group showed significant differences(P<0.05).After treatment,there was no significant differences between the combined treatment group and the healthy examinees in ADP-PAGM,AA-PAGM and MCA-MV(P>0.05).3.There was no significant difference between the monotherapy group before and after treatment in the lasting time of pain(P>0.05),but,VAS,ADP-PAGM,AA-PAGM and MCA-MV showed significant differences after treatment(P<0.05).After treatment,there were still significant differences between the monotherapy group and the healthy examinees in ADP-PAGM AA-PAGM and MCA-MV(P<0.05).4.After treatment,the response rate of the combined treatment group was19(63.33%),and the monotherapy treatment group was 11(36.67%).After the?~2 test(?~2=4.271,P=0.042),the difference was statistically significant(P>0.05).After test of“t”,compared with combined treatment group and the monotherapy treatment group,the number of days of migraine(t=2.231,P=0.028),lasting time of pain(t=2.953,P=0.015),VAS(t=2.134,P=0.033),ADP-PAGM(t=4.991,P(27)0.001),AA-PAGM(t=3.152,P(27)0.001)and MCA-MV(t=2.871,P=0.013),the difference is statistically significant(P<0.05).5.During the treatment,1 case of facial flush appeared in the combined treatment group,and 1 case of dizziness appeared in the flunarizine group.The degree of adverse events in the two groups was mild,and no special treatment was acted.Conclusion:1.Compared with healthy subjects,migraine patients had faster blood flow and higher maximal platelet aggregation rate in the middle cerebral artery,suggesting that migraine patients may be involved in the occurrence of migraine.2.Nicergoline combined with flunarizine can significantly reduce the number of days of migraine attack,shorten the duration of headache and reduce the severity of headache,and its therapeutic effect is better than flunarizine alone.3.In the short term,treatment of migraine with flunarizine plus nicergoline did not increase the incidence of adverse events.4.Nicergoline combined with flunarizine significantly improved the mean blood flow velocity and maximum platelet aggregation rate of migraine patients,and even restored to the level of healthy physical examinees.