Antiepileptic drugs for migraine prophylaxis
Keywords:
antiepileptics, migraine, prophylaxisAbstract
Migraine is a chronic, debilitating, incurable disease with high socio-economic burden. Migraine starts as and may remain confined to an episodic disorder, but in some patients episodic evolves into chronic. The goals of migraine prevention are to reduce frequency, duration, or severity of attacks.
Additional benefits include enhancement of response to acute treatments, improvement of patient’s ability to function, and reduction of disability and the fact that prevention may impede the transformation from episodic to chronic migraine. The use of antiepileptics in prevention of migraine rely the hypothesis that migraine and epilepsy share some pathogenic mechanisms. Within the guidelines, the only antiepileptic drugs with established efficacy in migraine prevention are valproates and topiramate. Drugs should be started at low dose, raised to optimal dosage, and continued for long period in order to exert disease-modifying effect. Valproates and topiramate are contraindicated during pregnancy and there are some limitations in child and adolescent age.
Further research on antiepileptic drugs is needed in order to achieve better understanding about their pharmacodynamic properties in migraine.
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