[Use of antiepileptic drugs for the preventive treatment of migraine].
Migraine and epilepsy share several common characteristic clinical features, and epilepsy is a comorbid disorder of migraine. Clinical studies have shown that some antiepileptic drugs are effective for the preventive treatment of migraine. The rationale for the use of these antiepileptic drugs in migraine prophylaxis is the hypothesis that migraine and epilepsy have several common pathophysiological mechanisms. It has been suggested that in these 2 pathological conditions, an imbalance exists between excitatory glutamate-mediated transmission and inhibitory GABA-mediated transmission in cerebral tissues, mainly in specific brain areas. Moreover, it has been postulated that abnormal activation of some kinds of voltage-gated ionic channels has been postulated to have a key role in both migraine and epilepsy, especially when caused by a genetic abnormality. It has been found that cortical spreading depression is involved in the pathophysiological mechanism of epilepsy, in addition to the generation of migraine aura. Preventive antiepileptic drugs can be chosen for treatment after considering clinical efficacy- scientific evidence, side effects, and patients' specific personal conditions. Recently, scientific evidence was found to demonstrate efficacy of valproic acid and topiramate in the preventive treatment of migraine. These drugs can reduce the incidence of migraine attacks in the large clinical studies. Other new antiepileptic drugs can be tried in future clinical study.
Hamada
Junichi
J
Department o f Neurology, Kitasato University School Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
D000588:Amines / Q000008:administration & dosage*; D000927:Anticonvulsants / Q000008:administration & dosage*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077206:Gabapentin; D005971:Glutamates / Q000502:physiology; D006801:Humans; D007473:Ion Channels / Q000502:physiology; D008881:Migraine Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011292:Premedication; D009435:Synaptic Transmission / Q000502:physiology; D000077236:Topiramate; D014635:Valproic Acid / Q000008:administration & dosage*; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage* / Q000502:physiology
D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D005971:Glutamates; D007473:Ion Channels; D000077236:Topiramate; D005632:Fructose; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D000077206:Gabapentin