What is the role of antiepileptics in migraine prevention?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
  • Print
Answer

Antiepileptics are generally well tolerated. The main adverse effects of topiramate are weight loss and dysesthesia. [109] Valproic acid (Depakote) is useful as a first-line agent. It is a good mood stabilizer and can benefit patients with concomitant mood swings. However, it can cause weight gain, hair loss, and polycystic ovary disease; therefore, it may not be ideal for young female patients who have a tendency to gain weight.

Valproic acid also carries substantial risks in pregnancy; it may be best suited for women who have had tubal ligation and who cannot tolerate calcium channel blockers because of dizziness. Data for other antiepileptics (eg, gabapentin, [110] lamotrigine, oxcarbazepine) are limited in migraine.

Topiramate is approved in the U.S. for migraine prophylaxis in adults and adolescents aged 12 years or older. The safety and effectiveness of topiramate in preventing migraine headaches in adolescents were established in a clinical trial of 103 participants. Frequency of migraine decreased by approximately 72% in treated patients, compared with 44% in participants receiving placebo. [111, 112]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!