Prophylactic treatment of migraine with beta-blockers and riboflavin: Differential effects on the intensity dependence of auditory evoked cortical potentials

Objective.-To investigate the influence of different pharmacological treatm ents on the intensity dependence of auditory evoked cortical potentials in migraineurs, Background.-Between attacks, patients with migraine show abnormalities in c ortical information processing and decreased brain mitochondrial energy res erve. Both are most probably relevant for migraine pathogenesis, and they c ould be differentially modified by prophylactic drug therapy. Design.-The intensity dependence of the auditory evoked cortical potentials is, on average, increased in migraine. We have studied this intensity depe ndence in 26 patients before and after a 4-month period of prophylaxis with beta-blockers (n =11, all migraine without aura; metoprolol or bisoprolol) or riboflavin (n = 15, migraine without aura: 13, migraine with aura: 2), Recordings were performed at least 3 days before or after an attack. Results.-After the treatment with beta-blockers, the intensity dependence o f the auditory evoked cortical potentials was significantly decreased (befo re: 1.66 +/- 1.02 mu V/10 dB; after: 0.79 +/- 1.06 mu V/10 dB, P=.02). The decrease in intensity dependence was correlated significantly with clinical improvement (r=.69, P=.02). There was no change in intensity dependence af ter riboflavin treatment (before: 1.80 +/- 0.81 mu V/10 dB; after: 1.56 +/- 0.83 mu V/10 dB, P=.39), although the majority of patients showed improvem ent. Conclusions.-These results confirm that beta-blockers and riboflavin act on two distinct pathophysiological mechanisms. Combining both treatments migh t enhance their efficacy without increasing central nervous system side eff ects.