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Anticonvulsant drugs for migraine prophylaxis
1Department of Psychology, University of Hawaii at Manoa, 2430 Campus Road, Honolulu, Hawaii, USA, 96822.
The Cochrane Database of Systematic Reviews
|July 22, 2004
Summary
Anticonvulsants effectively reduce migraine frequency and are well-tolerated. While individual drug efficacy varies, this class of medication offers a valuable option for migraine prophylaxis, with notable agents including divalproex sodium and topiramate.
Area of Science:
- Neurology
- Pharmacology
Background:
- Anticonvulsant drugs show promise in migraine prophylaxis.
- Their central nervous system actions are relevant to migraine pathophysiology.
Purpose of the Study:
- To assess the efficacy and tolerability of anticonvulsants for migraine prevention in adults.
- Review evidence from controlled trials.
Main Methods:
- Searched MEDLINE and Cochrane CENTRAL up to April 2003.
- Included prospective, controlled trials of regular anticonvulsant use for migraine prevention.
- Extracted data on migraine frequency, response rates, and adverse events.
Main Results:
- Anticonvulsants as a class reduced migraine frequency by 1.4 attacks/28 days versus placebo.
- More than doubled the likelihood of a 50% or greater reduction in migraine frequency (NNT 3.8).
- Tolerability varied, with Numbers-Needed-to-Harm (NNH) ranging from 2.4 to 32.9 for specific agents.
Conclusions:
- Anticonvulsants are effective and generally well-tolerated for migraine prevention.
- Significant variation exists among individual agents, requiring further investigation.
- Sodium valproate/divalproex sodium and topiramate show promising efficacy.