Weight Loss

This is a powerful anti-5HT agent, as well as antihistamine. After two weeks of taking the standard dose of three tablets a day, about 80 per cent of patients will notice a lessening of the frequency of migraine headaches. There is a mild antidepressant effect and another benefit is that any concomitant allergies are improved.

A 27-year-old casualty doctor found that he began to have severe migraine attacks every week. The headaches used to begin behind his right eye, which became red and watered. Instead of the pain lasting a short time, as in cluster headache, there would then ensue a severe headache lasting many hours which was accompanied by vomiting. This made it extremely difficult to work the long hours expected and he felt guilty when his friends had to ‘cover’ for him during a migraine. Examination revealed no abnormality and he began to take pizotifen. Within two weeks the headaches stopped and he was able to pass a stiff examination shortly afterwards. He suffered from hay fever but reported that, although the pollen count was high, this had also disappeared. After six months the treatment was phased out and the headaches did not return.

Half the patients who are helped by this treatment do not get a recurrence of headaches once treatment has stopped. It is as if the blood vessels ‘unlearn’ their previous pattern of response and no longer go through the variations in caliber associated with the migraine attack.

There are two main unwanted effects with this drug. The first is drowsiness, so that the manufacturers advice care when driving, and suggest that alcohol is not drunk while on treatment, a caution that also applies to other anti-5HT, as well as antihistamine, agents. The other effect is that about one-third of patients put on weight of the order of half a stone, because inhibiting 5HT in the brain (which happens to a slight extent) increases the appetite.

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