title: Antiepileptics in migraine prophylaxis: an updated Cochrane review.
abstract: BACKGROUND
  The efficacy of several antiepileptics in the preventive treatment of episodic migraine in adults has been systematically reviewed. Because many trial reports have been published since then, an updated systematic review was warranted.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE (1966 to January 15, 2013), MEDLINE In-Process (current week, January 15, 2013), and EMBASE (1974 to January 15, 2013) and hand-searched Headache and Cephalalgia through January 2013. Prospective, controlled trials of antiepileptics taken regularly to prevent the occurrence of migraine attacks, to improve migraine-related quality of life, or both, were selected.
  
  
  RESULTS
  Mean headache frequency on topiramate and sodium valproate is significantly lower than placebo. Likewise, topiramate and divalproex demonstrated favorable results for the proportion of subjects with ≥ 50% reduction of migraine attacks. For topiramate, 100 mg and 200 mg outperformed 50 mg, but this was paralleled by a higher adverse event rate. For valproate/divalproex, a dose-effect correlation could not be established. There was no unequivocal evidence of efficacy for any of the other antiepileptics.
  
  
  CONCLUSIONS
  Topiramate, sodium valproate and divalproex are effective prophylactic treatments for episodic migraine in adults. In contrast to previous reports, there is insufficient evidence to further support the use of gabapentin.
authors.affiliation: Department of Neurology, Canisius Wilhelmina Ziekenhuis, The Netherlands w.mulleners@cwz.nl.
authors.forename: Wim M
authors.initials: WM
authors.lastname: Mulleners
authors.affiliation: Department of Medicine, Duke University Medical Center, NC, USA Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: McCrory
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Norway Norwegian National Headache Centre, St. Olavs University Hospital, Norway.
authors.forename: Mattias
authors.initials: M
authors.lastname: Linde
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D006801:Humans; D008881:Migraine Disorders / Q000517:prevention & control*
chemical_list: D000927:Anticonvulsants
keywords: Migraine; antiepileptic; preventive treatment; prophylactic treatment; prophylaxis