***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Migraine is a painful condition in which patients suffer from recurrent episodes of disabling pain , which could be very severe and can lead to grave psychological disturbances . There is no curative treatment for migraine , but there are various treatment modalities , though , with conflicting reports on their efficacy . This study was conducted to compare the effectiveness of electro acupuncture therapy and the conventional drug therapy on the psychological profile of migraneurs based on the assessment of quality of life and disability parameters .  Migraneurs ( n = 60 ) were recruited from the Psychiatry and Neurology OPD , Guru Tegh Bahadur Hospital , Delhi . Following a written consent , migraneurs were r and omly allocated into 2 study groups -- Group A received 10 sittings of electro acupuncture on selected acupuncture points over a period of 30 days , while for the same duration the Group D received a conventional drug therapy in the form of oral flunarizine 20 mg OD along with paracetamol 500 mg SOS . The patients were assessed twice , before and after completion of the treatment programme ( 30 days ) . The quality of life was assessed with WHOQOL BREF ( WHO Quality of Life Biomedical Research and Education Foundation ) question naire and the disability was assessed with MIDAS ( Migraine Disability Assessment ) question naire . Statistical analysis was performed using repeated measure 's ANOVA with Tukey 's test . Migraneurs were found to have lower quality of life and higher disability scores but following the treatment regimes , the 2 study groups showed a significant improvement in both the parameters studied . It was however observed , that the acupuncture group showed a better response and was thus found to be more effective as compared to the drug group ( P = 0.005 to 0.000 ) . We thus conclude that acupuncture is a better treatment option than the conventional drug therapy in not only relieving the pain of migraine but in also improving the psychological profile in migraneurs . Hence its use should be encouraged as an alternative/adjunct treatment for migraine The effects of flunarizine administration ( 10 mg/day , at bed time ) were studied in 120 common migraine patients who were followed for 24 months with quarterly controls . Besides headache index ( HI ) and analgesic use , other variables were monitored , such as arousal ( Tolouse Pieron test ) , mood ( Hamilton rating scale for depression ) , sleep/wake ( hrs ) and body weight . The study was open-type and after the 6th month control some responder ( R ) cases ( HI reduction ≥ 60 % ) presenting HI scores ≤ 4 could continue the survey off-treatment . The percentage of R cases was 54.5 % at the 3rd month , a figure that further increased up to 72 % by the 9th month ; relapses on treatment were not observed and rebound-headache occurred in 1/4 of R cases let off-treatment . Lower ( p < 0.05 ) baseline HI values characterized non-responders . Side-effects not requiring withdrawal were drowsiness ( 42 % within the 1st month ) and weight gain ( mean 7.9 ± 6.9 kg ) in 54 % of the cases , while a retarded type depression was the most frequent cause of drop-out from trial ( 7.5 % ) . The results , while confirming the high prophylactic activity of flunarizine in common migraine , stress the importance of clinical long-term survey of side-effects using antimigraine drugs and suggest the need for further investigations about flunarizine effects on CNS The calcium-entry blocker flunarizine ( Sibelium ; Janssen ) was compared with the beta-adrenoreceptor-blocking agent propranolol in the prophylaxis of  migraine . Fifty-eight patients were entered into a double-blind 4-month treatment trial . Patients in whom beta-blockers were contraindicated were excluded from the trial . At the end of the trial 28 patients had received 10 mg flunarizine  at night during the study , 29 patients had received 60 mg propranolol  3 times a day and 1 patient was withdrawn . Both groups responded well ; and there was a 4-fold drop in frequency of attacks . There was no significant difference between the two groups in terms of patient profile , onset of response to therapy , final response to therapy , incidence of dropout from the trial or incidence of side-effects . Side-effects for flunarizine were weight gain ( 9 patients ) and tiredness ( 6 ) , and for propranolol sleep disturbances including nightmares ( 6 ) , tiredness ( 8) , mental changes ( e.g. irritability ) ( 3 ) and weight gain ( 4 ) . Both flunarizine and propranolol are useful drugs for migraine prophylaxis and can be used effectively as first-line drugs . The low incidence of generally mild side-effects with flunarizine may make it preferable to many of the agents at present in use for migraine prophylaxis The clinical efficacy of flunarizine and of propranolol for the prevention of migraine attacks  was assessed in a multicenter double-blind study lasting four months which was preceded by a single-blind placebo period of one month . For both drugs , more than half of the patients judged the effect to be good or very good . When considering the patients ' daily logs , both drugs produced a significant reduction of the number of attacks .  Propranolol furthermore significantly reduced the severity of attacks and the number of analgesics used during the attacks . In both groups no severe side effects were observed The initiation of a prophylactic treatment in a migraine sufferer depends upon the stratification of the patient ’s frequency of attacks and the disability they cause , as well as the patient ’s acute consumption and comorbid diseases . We report on 14 patients who were among a group of 618 migraine sufferers who received a new preventative treatment .  These 14 patients developed an increase in the frequency of their migraine attacks that was possibly induced by this new prophylactic treatment . The clinical description of the migraine attacks remained the same but the frequency of the attacks of migraine without aura was dramatically increased . This is , to our knowledge , the first description of a possible precipitation of attacks of migraine without aura with a prophylactic treatment . There is no link with a specific class of prophylactic treatment . We hypothesize that the migraine sufferers who experienced aggravation after the new prophylactic drug had been introduced had a paradoxical decrease in the induction threshold for cortical spreading depression ( CSD ) . Mechanisms of such a decrease are unknown and are probably multifactorial , but changes in serotonin neurotransmission have been experimentally demonstrated to modify cortical excitability and favour CSD . The aggravation was described only for attacks without aura . However , with only 14 patients , it is not possible to predict whether suffering from that the type of migraine is a factor that predisposes a patient to aggravation . While additional cases are necessary , physicians should be aware of the possibility that prophylactic treatment may exacerbate migraine attacks SYNOPSIS Fourty-five migraine without aura patients underwent a parallel double-blind trial aim ing the comparison of the effects of propranolol 60 mg/day to flunarizine 10 mg/day and to propranolol 60 mg/day plus flunarizine 10 mg/day simultaneously . There were 3 groups , each one with 15 patients . After a 20-day-baseline period , each group received one kind of treatment during 120 days . Migraine index on propranolol was 23.4 * , on flunarizine 18.7 * and on both drugs 14.4 * , mean frequency of attacks on propranolol was 1.26 * * , on flunarizine 1.2 * * and on both drugs 1.13 * * ( * p < 0.05 , * * p < 0.01 compared to baseline ) and global evaluation was reduced with all forms of treatment . It was not found statistical differences between groups , nevertheless there was a trend in the group using two drugs reaching lower values in migraine index , frequency of attacks and global evaluation . In individuals using flunarizine ( alone or associated with propranolol ) the therapeutic effect was largely maintained up to 45 days after drug withdrawal Summary This multicenter , double‐dummy trial suggested that acupuncture was more effective than flunarizine in decreasing days of migraine attacks . ABSTRACT Insufficient clinical trial data were available to prove the efficacy of acupuncture for migraine prophylaxis . A multicenter , double‐dummy , single‐blinded , r and omized controlled clinical trial was conducted at the outpatient departments of acupuncture at 5 hospitals in China to evaluate the effectiveness of acupuncture . A total of 140 patients with migraine without aura were recruited and assigned r and omly to 2 different groups : the acupuncture group treated with verum acupuncture plus placebo and the control group treated with sham acupuncture plus flunarizine . Treated by acupuncture 3 times per week and drugs every night , patients from both groups were evaluated at week 0 ( baseline ) , week 4 , and week 16 . The primary outcome was measured by the proportion of responders ( defined as the proportion of patients with a reduction of migraine days by at least 50 % ) . The secondary outcome measures included the number of migraine days , visual analogue scale ( VAS , 0 to 10 cm ) for pain , as well as the physical and mental component summary scores of the 36‐item short‐form health survey ( SF‐36 ) . The patients in the acupuncture group had better responder rates and fewer migraine days compared with the control group ( P < .05 ) , whereas there were no significant differences between the 2 groups in VAS scores and SF‐36 physical and mental component summary scores ( P > .05 ) . The results suggested that acupuncture was more effective than flunarizine in decreasing days of migraine attacks , whereas no significantly differences were found between acupuncture and flunarizine in reduction of pain intensity and improvement of the quality of life This study was design ed to compare flunarizine , a cerebro-specific calcium channel antagonist , and propranolol in the prophylaxis of  migraine with or without aura . Following a 1 month single-blind placebo baseline period , 94 patients were equitably r and omised under double-blind conditions to take flunarizine 10 mg daily or propranolol 80 mg twice daily for 4 months . Both treatments led to a significant reduction in the frequency of migraines and use of rescue analgesics with a significantly greater decrease in number of attacks for flunarizine after 1 and 4 months . Neither treatment affected the severity nor duration of migraines . Overall , 67 % of flunarizine patients and 51 % of propranolol patients responded positively . Propranolol significantly reduced blood pressure and heart rate ; flunarizine had no effect on cardiovascular function . Weight gain was noted with both treatments . Flunarizine is at least as effective as propranolol in the prophylactic treatment of migraine and may have a better safety profile Pharmacological data and early clinical experience have suggested that the calcium entry blocker flunarizine may be a valuable gain in the prophylaxis of  migraine .  This was supported by a study in 20 patients with classical migraine who were , after a drug free run-in phase , orally treated with either  placebo or flunarizine  ( 10 mg at night ) for 3 to 4 months . Flunarizine significantly reduced the frequency , duration and severity of the migraine attacks . A corrected migraine index , based on these 3 variables was reduced by 82 % in the drug group but increased by 66 % in the control patients . Only 1 patient did not clearly benefit from flunarizine . In some cases flunarizine should be administered for at least 4 months before judging its efficacy . No side-effects occurred The aim of this study was to compare the efficacy and safety of valproate versus flunarizine in migraine prophylaxis in a r and omized double-open clinical trial . Twenty-two migraine sufferers were treated with valproate ( 1 g per day ) for 8 weeks ; a parallel group of 22 migraine sufferers was treated with flunarizine ( 10 mg per day ) . The main admission criterion was a minimum of 3 migraine ( with , or without aura ) attacks per month . The major clinical parameters evaluated were the frequency of headache attacks , the frequency of use of drugs for the acute management of migraine , the patients ' opinion of treatment and the Hamilton anxiety and depression rating scales . During the study 3 patients dropped out ( 1 from the valproate and 2 from the flunarizine groups ) . Fifteen patients ( 71.4 % ) from the valproate group responded to therapy , compared to 14 patients ( 65 % ) from the flunarizine group . In the valproate group 12 patients ( 57.1 % ) reported various side effects ( prevalently gastric symptoms ) versus 10 patients ( 47.6 % ) in the flunarizine group ( prevalently somnolence ) . The patients who were treated with flunarizine showed an increase in the mean score of the 21-item Hamilton rating scale for depression , but the difference was not significant ; morning dysthymia however , was significantly more often observed in the flunarizine patients , compared to the valproate patients . These results suggest that both drugs are effective and safe in migraine prophylaxis Objectives .—In a r and omized controlled trial extending over 6 months , we evaluated the effectiveness of acupuncture versus flunarizine  in the prophylactic treatment of migraine without aura Sixty-four Spanish neurological centers participated in a study design ed to evaluate the efficacy and safety of flunarizine in migraine . One thous and four hundred and thirty-five out patients ( 367 [ 25.6 % ] males and 1,068 
    Output:
    
Flunarizine also seems to be effective in children .
The most frequent AEs were sedation and weight increase .