Efficacy and mechanism of anticonvulsant drugs in migraine.
Anticonvulsants represent one of the main substance classes used for the preventive treatment of migraine. Efficacy has been demonstrated in randomized placebo-controlled trials for topiramate and valproic acid including divalproex sodium. In the case of topiramate, efficacy has recently been proven for chronic migraine and even medication overuse headache, questioning the established concept of medication withdrawal. However, preventive treatment with anticonvulsants is frequently hampered by side effects that occasionally require treatment discontinuation. In addition, these data indicate that some anticonvulsant drugs are effective in migraine, while a number are clearly not useful. Effective anticonvulsants, such as topiramate and valproate, target nociceptive trigeminovascular and trigeminothalamic dural pathways or mechanisms involved in cortical spreading depression. Dissecting out how the anticonvulsants that do not work differ mechanistically from those that do will almost certainly provide avenues through which one can develop new treatments to bring to patients with migraine.
Headache Group-Department of Neurology, University of California, San Francisco, CA, USA.
Jan
J
Hoffmann
Simon
S
Akerman
Peter J
PJ
Goadsby
D000818:Animals; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D013181:Cortical Spreading Depression / Q000187:drug effects; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008881:Migraine Disorders / Q000503:physiopathology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D000077236:Topiramate; D014635:Valproic Acid / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose; D014635:Valproic Acid