Lamotrigine in the Prevention of Migraine With Aura

A Narrative Review

Dan Buch, MD; Hugues Chabriat, MD, PhD

Disclosures

Headache. 2019;59(8):1187-1197. 

In This Article

Abstract and Introduction

Abstract

Background: Lamotrigine is not recommended in the prevention of migraine in general but some reports suggest that it might be effective for treating specifically migraine with aura (MA). This review aims to summarize the related data from the literature and to better understand this discrepancy.

Methods: All reports from the literature related to the use of lamotrigine in migraine with or without aura published prior to February 2019 found using PUBMED and the 2 keywords "migraine" AND "lamotrigine" were reviewed. Original studies, published in full, systematic reviews, and all case reports were synthetized. We also examined the risk profile, pharmacokinetics, and mode of action of lamotrigine in view of the presumed mechanism of MA.

Results: Lamotrigine was tested in different populations of migraineurs, but previous studies had small sample sizes (n < 35) and might not have been powered enough for detecting a potential benefit of lamotrigine in MA. Accumulating data suggest that the drug can reduce both the frequency and severity of aura symptoms in multiple conditions and is well tolerated.

Conclusion: Lamotrigine appears promising for treating attacks of MA and related clinical manifestations because of its high potential of efficacy, low-risk profile, and cost. Additional studies are needed for testing lamotrigine in patients with MA.

Introduction

There is accumulating evidence suggesting that migraine with aura (MA) can result from minor changes of neuronal excitability at cortical level. Subtle functional alterations of voltage-gated ionic channels were previously found able to change the regulation of cortical excitability and to promote the occurrence of cortical spreading depression (CSD), a critical physiological substrate of MA.[1–4] Among all potential drugs interacting with ionic channels and that can alter the occurrence of CSD, lamotrigine (LTG) appears particularly promising. This treatment is not usually recommended in the prevention of migraine but was not previously assessed specifically in patients with MA. This review aims to analyze data in the literature related to the potential preventive effects of LTG in MA.

Comments

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