Abstract Details

Title Mexiletine for the Treatment of Refractory Chronic Migraine: A Retrospective Chart Review

Topic Headache

Presentation(s) P6 - Poster Session 6 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-005

Objective

This is the first study to describe dosing, time to discontinuation, and adverse effects of mexiletine in a complete cohort of patients for migraine treatment.

Background Intravenous lidocaine infusion is commonly used at Thomas Jefferson Headache Center during inpatient admission for treatment of refractory chronic migraine. Patients are subsequently discharged on mexiletine (similar to lidocaine, a class 1B sodium channel antagonist) as a new daily preventive medication.

Design/Methods Electronic medical records were reviewed of 373 patients admitted for first-time lidocaine infusion for refractory chronic migraine between 1/2019- 4/2020 with ≥ 1 post-discharge follow up visit. Pain scores were collected at time of admission, discharge, and at up to 6 office visits within 1 year post discharge.

Results

After lidocaine infusion, almost all patients were initially prescribed a daily dose of mexiletine 450 mg (150 mg TID). Patients who discontinued mexiletine due to side effects usually did so at this starting dose. The median final total daily dose for patients who remained on mexiletine was 600 mg (ranging 150 mg to 1350 mg).

40% of patients were still taking mexiletine around 500 days after discharge and 30% of patients were still taking mexiletine around 700 days on Kaplan-Meier curves. The two most common reasons for discontinuation were side effects (57%) and inadequate treatment response (17%). Nausea, vomiting, dizziness, and tremor were the most common side effects.

Wilcox test of pain scores and monthly headache days at the first office visit compared to admission was highly statistically significant (p-value<0.00001). However, there was no correlation between pain scores and mexiletine doses/levels.

Conclusions Dizziness during lidocaine administration (p-value=0.0008) and lower tolerated lidocaine infusion rates (p-value=0.001) were predictive of shorter number of days on mexiletine treatment. A lower starting dose should be considered on these patients. Further research is needed on the direct effectiveness of mexiletine in migraine treatment.

Authors/Disclosures
Lucia Liao, MD (Jefferson) PRESENTER	Dr. Liao has nothing to disclose.
Dylan A. Selbst	Mr. Selbst has nothing to disclose.
Emily Casaletto	Miss Casaletto has nothing to disclose.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center)	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.
Clinton G. Lauritsen, MD (Thomas Jefferson University Hospital)	Dr. Lauritsen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan. Dr. Lauritsen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Lauritsen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Allergan.

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