regional cerebral blood flow ( rcbf ) studies have been employed to investigate the pathophysiology of migraine headache [ 13 ] . the introduction of brain single - photon emission computed tomography ( spect ) using technetium tc 99m- ( tc- ) labelled hexamethylpropyleneamine oxime ( hmpao ) or ethyl cysteinate dimer ( ecd ) has facilitated assessment of rcbf . a number of rcbf studies using tc 99 m hmpao or ecd spect have been reported in patients with migraine during prodromes or headache phases [ 38 ] . lomerizine , 1-(bis(4-fluorophenyl)methyl)-4-(2,3,4-trimethoxybenzyl ) piperazine dihydrochloride , is a calcium channel blocker with antimigraine properties . we first report a unique case in which prophylactic treatment with lomerizine recovered brain hypoperfusion on tc ecd spect during interictal period , in addition to dramatic amelioration of migraine attacks . a 70-year - old man developed visual disturbance frequently at walking exercise for the recent 3 months . visual disturbance consisted of scintillating scotoma in both eyes , which continued 520 minutes . he had prior history of migraine with aura ( ma ) and without aura ( mo ) from 30 years of age . after 60 years of age , migraine attacks were decreased to a few times per one year . fasting blood sugar level was 144  mg / dl , and hemoglobin a1c was 6.6% ( normal 4.35.8 ) . brain spect scanning with tc - ecd was performed at the interictal time of migraine . spect was scanned at 10 minutes after intravenous bolus injection of 1.5  ml ( 600  mbq ) , tc - ecd spect examination was performed using a rotating -camera ( prism 3000 ; picker corp . one of spect analyses used the revised version of 3-dimensional stereotaxic region of interest template ( 3dsrt ) by takeuchi et al . . global cbf was calculated from all data of 636 rois in whole brain , including both cerebral hemispheres and cerebellum . spect images were divided as regional cbf into 24 symmetrical ( right and left ) regions per patient : the callosomarginal , the precentral , the central region , the parietal region , the angular region , the temporal region , the posterior region , the pericallosal region , the lenticular nucleus , the thalamus , the hippocampus region and the cerebellar hemisphere . brain tc - ecd spect before lomerizine treatment revealed hypoperfusion in the frontal , temporal , parietal , and occipital lobes ( table 1 ) . lomerizine ( 10  mg / day , po ) was administered for 3 months . there were no migraine attacks and visual disturbance whenever he walked and exercised for long time . we showed that prophylactic treatment with lomerizine ameliorated brain hypoperfusion during the interictal period in a patient with ma , together with complete prevention of migraine attacks and visual auras . lomerizine , an antimigraine calcium channel blocker , is prescribed widely in japanese migraineurs [ 1013 ] . lomerizine belongs to the same class of diphenylpiperazine - type calcium antagonists as flunarizine , and this drug is prescribed for migraine prophylaxis in japan . previous clinical trials of lomerizine suggested that this drug reduced the frequency of migraine attacks over 12 weeks [ 1012 ] . little is known about how these drugs influence rcbf on brain spect during the headache attack or the interictal phase in migraineurs . prophylactic effects of magnesium citrate supplementation ( 600  mg / day , po ) were assessed by means of clinical evaluation , visual evoked potential , and statistical parametric mapping of brain spect before and after 3 months treatment . magnesium treatment significantly increased cbf in the inferolateral frontal , inferolateral temporal , and insular regions . inhibitory effects of lomerizine on the cortical hypoperfusion and expression of c - fos - like immunoreactivity induced by spreading depression in anaesthetized rats were mediated via the effects of ca - entry blockade , which may include an increase in cbf and the prevention of excessive ca influx into brain cells . these results provide the possibility that lomerizine may potentiate cbf and inhibit cortical spreading depression in migraine . lomerizine had a greater effect on cbf than on blood pressure and heart rates in anaesthetized rats and beagle dogs . this drug is reported to inhibit voltage - dependent ca channels and 5-hydroxytryptamine ( 5-ht)2a receptors , leading to suppression of 5-ht - induced contraction in rat basilar artery . recent study has disclosed that lomerizine recovered visual function in an experimental animal model of optic nerve injury . therefore , these experimental profiles supported that lomerizine could be clinically effective in cerebral circulatory disturbances , such as migraine status . further spect studies with numerous migraineurs are needed to elucidate the precise prophylactic mechanism of lomerizine . after lomerizine administration had improved ma or visual aura in our patient , brain spect revealed restoration of decreased cbfs during the interictal period . clinicoradiological features of our patients indicated that antimigraine mechanism of lomerizine could contribute to alleviation of interictal cerebral hypoperfusion .