ANA 2012 (Boston, MA)
Tuesday October 9, 2012: 1730 - 1900
OBJECTIVE: Toreport the use of fixed combination dextrometherophan/quinidine (DM/Q) inchronic daily headache (CDH) prophylaxis.
BACKGROUND: Nuedexta®is a non-competitive N-Methyl-D-aspartic acid (NMDA) receptor antagonist andsigma-1 agonist combination of DM/Q 20/10mg approved for pseudoublbar affect. DM/Qis being studied in diabetic and multiple sclerosis pain. Other NMDA receptor antagonistsare sometimes used for headaches.
METHODS: Casereport.
RESULTS: A 54-year-oldwoman with a >20 year history of refractory CDH (intensity 2–7/10) isstarted on DM/Q due its role in down-regulating glutamate. Within the firstmonth of treatment, her headache intensity dropped to 1/10 (infrequently 2/10)and headache frequency dropped from daily to several times a week. Herinfrequent migraines became even less frequent and severe. Excedrin use droppedfrom four times a day to twice in the first month and she discontinuedpercocet. This dramatic result has been sustained for over a year.
CONCLUSIONS: Mechanistically,DM/Q may be expected to be helpful in the treatment of headache/pain. Althoughit is possible that our patient demonstrated a placebo response, the failure ofmultiple other medications suggests that this may represent a true therapeuticresponse. Further research is warranted.
- Dr. Daniel Kantor, MD
Medical Director
Neurologique
info@neurologique.org
www.neurologique.org
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