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Experience with propranolol hydrochloride as an effective agent in the prophylaxis of migraine dates from the mid-1960s. 1-3 A series of uncontrolled observations was published then, leading to subsequent controlled data that confirmed these observations in the next decade. 4-6 Subsequently, as the number of β-blockers proliferated, like mushrooms in a bog, questions have arisen regarding their relative efficacy in migraine prophylaxis. To wit, which drug to use? Is one drug better than the other? Physicians who treat migraine, already confronted by patients holding their heads, and beset by shadows dancing on the wall, have been unable to answer these queries. That may still be the case, but enough information pertaining to β-blockers and migraine has now been accumulated from various sources to be summarized in tabular form (Table). In a study published in this issue (p 2576), Stellar et al 7 have reconfirmed that migraine can be prevented by

This was a double-blind clinical trial designed to assess the efficacy and safety of the cinnarizine (CIN) in patients with migraine who were refractory to propranolol and tricyclic antidepressants in comparison with sodium valproate (SV) to investigate whether CIN could be at least as effective as SV. A total of 125 patients were treated in a treatment period of 12 weeks. All patients had at least one intake of trial medication and 2-week post baseline efficacy observation which all were included in the ITT analysis. Of the 125 subjects treated, 46 discontinued prematurely: 25 from the CIN and 21 from the SV group. The main reasons for premature discontinuation were: lost to follow up (25/46, 63.2%), insufficient response (16/46, 20%), and adverse events (5/46, 12.8%). No statistically significant inter-group differences in the number of discontinuation was observed (p > 0.05). In both groups, number of attacks, intensity, and duration of attacks significantly decreased (p