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Objectives: To compare the effectiveness and tolerability of flunarizine and amitriptyline in migraine prophylaxis. Also to assess the disability associated with migraine using Migraine Disability Assessment Test (MIDAS) and Headache Impact Test-6 (HIT-6) questionnaires. Materials and Methods: The study was a prospective observational, open-label, comparative study, conducted for six months among migraine patients attending Tertiary Care Hospital, Mandya. Patients were prescribed either Amitriptyline 25 mg or flunarizine 10 mg OD for three months. Effectiveness was assessed by the number of episodes of migraine attacks, pain severity score on Visual Analogue Scale (VAS), tolerability of adverse reactions reported and disability assessed using MIDAS and HIT-6 questionnaires. Results: Out of 103 patients, 55 were prescribed Amitriptyline and 48 patients flunarizine. 49.5% of patients were between 18 to 30 years of age. At the end of three months of treatment, the frequency and severity of headaches decreased from baseline in both the groups. The overall percentage of responders with >50% reduction from baseline in number of migraine episodes and pain severity together were 67.3% and 50% in amitriptyline and flunarizine groups respectively. There was reduction in MIDAS and HIT-6 scores in both groups, without significant difference between the groups. Both the drugs were well tolerated, with most common adverse effects being dry mouth, somnolence, and constipation. Conclusion: Both amitriptyline and flunarizine are effective in prophylaxis of migraine, with significant reduction in number of episodes and severity of headache from baseline to end of treatment. However, Amitriptyline had a higher overall responder rate when compared to Flunarizine, with similar tolerability profile.  Keywords: Migraine prophylaxis, Amitriptyline, Flunarizine, MIDAS, HIT-6.

Oral flunarizine versus oral amitriptyline in migraine prophylaxis – A prospective open label study