Dr. Geoffrey Paul Nase Editorial - Clinical & Anecdotal Observations:

Zanaflex (tizanidine) is a medication that is used primarily for muscle spasms... and lately for migraines and daily headaches. Dr. Geoffrey P. Nase is a Neurovascular Physiologist who has studied the neural and vascular actions of this drug in various disease states. It works centrally in the brain to reduce pain impulses and reduces nerve activity going out to the skin and muscles. It works on blood vessels and nerves... much like rosacea targetted medications.

Dr. Geoffrey Paul Nase Update: Short release vs. extended release zanaflex. Now there is a once a day, extended release form of Zanaflex. Anecdotal reports from rosacea sufferers and physicians indicate that Zanaflex Extended Release might be more effective than clonidine or beta blockers when used sparingly (e.g. special occasions or stressful events) if kept to only a few days of treatment in a row and then a drug holiday.

Zanaflex's recent studies on migraines (neurovascular disorder of brain blood vessels) gives us considerable insight into its mechanism of action and why this is so effective for some forms of facial flushing. In fact, migraine sufferers who experience pain and get red faced (but dont have rosacea) often report that the facial redness dissipates while on Zanaflex EX.

If you are a frequent blusher or flusher and plan to use this on special occassions, please discuss this treatment with your physician and based on its half life, discuss how often you can use it and how long you need to take a break from this med for it to keep its effectiveness.

As you can see below, migraine sufferers and those with daily neurovascular headaches are using the extended release capsule on a daily basis with excellent results... and remember, clinical studies demonstrate that rosacea sufferers are more prone to all forms of headaches due to blood vessel vasospasms (opening and closing spontaneously via neurogenic input):

Headache. 2002 Jun;42(6):470-82.

Chronic daily headache prophylaxis with tizanidine: a double-blind, placebo-controlled, multicenter outcome study.

Saper JR, Lake AE 3rd, Cantrell DT, Winner PK, White JR.

Michigan Head-Pain and Neurological Institute, Ann Arbor 48104, USA.


Abstract

OBJECTIVE: To assess the efficacy of tizanidine hydrochloride versus placebo as adjunctive prophylactic therapy for chronic daily headache (chronic migraine, migrainous headache, or tension-type headache).

BACKGROUND: Tizanidine is an alpha2-adrenergic agonist that inhibits the release of norepinephrine at both the spinal cord and brain, with antinociceptive effects that are independent of the endogenous opioid system. Previous open-label studies have suggested the drug may be effective for treatment of chronic daily headache.

METHODS: Two hundred patients completed a 4-week, single-blind, placebo baseline period, with 134 fulfilling selection criteria and then randomized to tizanidine or placebo. Ninety-two patients completed at least 8 weeks of treatment (tizanidine, n = 45; placebo, n = 47), and 85 patients completed 12 weeks of treatment (tizanidine, n = 44; placebo, n = 41). Most patients (77%) met the diagnostic criteria for migraine of the International Headache Society; 23% had either chronic migrainous headache or chronic tension-type headache. Tizanidine was slowly titrated over 4 weeks to 24 mg or the maximum dose tolerated (mean, 18 mg; SD, 6.4; median, 20.0; range, 2 to 24), divided equally over three dose intervals per day. Overall headache index ([headache days x average intensity x duration in hours]/28 days) was the primary end point. RESULTS: Tizanidine was shown to be superior to placebo in reducing the overall headache index (P =.0025), as well as mean headache days per week (P =.0193), severe headache days per week (P =.0211), average headache intensity (P =.0108), peak headache intensity (P =.0020), and mean headache duration (P =.0127). The mean percentage improvement during the last 4 weeks of treatment with tizanidine versus placebo was 54% versus 19% for the headache index (P =.0144), 55% versus 21% for severe headache days (P =.0331), 35% versus 19% for headache duration (P =.0142), 35% versus 20% for peak headache intensity (P =.0106), 33% versus 20% for average headache intensity (P =.0281), and 30% versus 22% for total headache days (P =.0593). Patients receiving tizanidine also scored higher ratings of overall headache improvement on a visual analog scale (P =.0069). There was no statistically significant difference in outcome for patients with chronic migraine versus those with only migrainous or tension-type headache. Adverse effects reported by more than 10% of the patients included somnolence (47%), dizziness (24%), dry mouth (23%), and asthenia (19%). Dropouts due to adverse events did not differ significantly between tizanidine and placebo.

CONCLUSIONS: The results support tizanidine as an effective prophylactic adjunct for chronic daily headache, including migraine, migrainous headache, and tension-type headache. These results also suggest the possible importance of an alpha2-adrenergic mechanism underlying the pathophysiology of this spectrum of headache disorders.


There is an excellent link detailing the use of tizanidine for rosacea, flushing and facial pain sensations (burning and stinging) that I worked on with "Angelfire - Sadhelp" and my rosacea book. It is quite clinical, but it is informative.

Lessons from Chronic Pain & Neuroplasticity

__________________
_

Best,
Geoffrey

Dr. Geoffrey Nase
Ph.D: Neuro-Vascular Physiologist

Email: drnase1000@hotmail.com
Bibliography: http://drnase.com

All posts are for informational purposes only. Please visit our Home Page to view our Medical Disclaimer.

Some rosacea sufferers respond better to zanaflex than they do to beta blockers or clonidine. It takes some trial and error, but with the recent release of a 24 hour extended release form of zanaflex, it makes this medication an even better choice for those with severe flushing and facial pain.

__________________
_

Best,
Geoffrey

Dr. Geoffrey Nase
Ph.D: Neuro-Vascular Physiologist

Email: drnase1000@hotmail.com
Bibliography: http://drnase.com

All posts are for informational purposes only. Please visit our Home Page to view our Medical Disclaimer.

Email Question: "Dr. Nase, how long would it take to determine if Zanaflex extended release had an effect of facial blushing or certain forms of flushing?"
Susan G.


Susan,

Like most oral medications you want to give it at least 6 to 8 weeks of continuous treatment before you start to evaluate its efficacy. You also need this amount of time to see how you respond to the lowest dose (6 mgs) and compare it to a medium dose (12 mgs).

With that said, some rosacea sufferers note a reduction in flushing intensity and duration almost right away... in the two week range.

Remember, discuss the extended 24 hour release with your physician and not the regular Zanaflex that only has a short half life of 4 hours.

__________________
_

Best,
Geoffrey

Dr. Geoffrey Nase
Ph.D: Neuro-Vascular Physiologist

Email: drnase1000@hotmail.com
Bibliography: http://drnase.com

All posts are for informational purposes only. Please visit our Home Page to view our Medical Disclaimer.

Any studies on its effect on synpathetic nerve activity or the hypothalamus.


Michael

Dr Nase,

Can you use zanaflex long term like clonidine or betablockers?

Michael