Lacosamide Versus Propranolol in Episodic Migraine, a Randomized Controlled Double-blinded Trial

Although migraine is the second most prevalent form of headache, its preventive treatment has some contraindications and complications. It has been postulated that lacosamide might inhibit CGRP release in the trigeminal system, which could contribute to migraine management. We aimed to evaluate the efficacy and safety of lacosamide as an alternative medication to propranolol for preventing episodic migraine, especially in patients who cannot tolerate propranolol and approved antiseizure medicines for migraine prevention. We recruited patients with episodic migraines; we had two groups: lacosamide group who received lacosamide 50 mg once daily for 1 week, then twice daily from the 8th day till the 90th day; propranolol group who received propranolol 40 mg twice daily for 1 week, then 80 mg twice daily from the 8th till the 90th day. 574 completed the study. In episodic migraine patients, there was no significant difference in the MMD in the last 4 weeks of treatment compared to baseline, the percentage of patients who achieved > 50% reduction in migraine days, reduction in MMD that required acute medication in the last 4 weeks, reduction in HIT score compared to baseline in both groups with P-values 0.13, 0.22, 0.57, and 0.61 respectively. In episodic migraine patients, the regular use of lacosamide 50 mg Bid for 3 months yielded reductions in the monthly migraine days, migraine days that required acute medications, and HIT6 score comparable to those achieved using propranolol 80mg Bid. Lacosamide was well-tolerated by migraine patients. Trial registration: registered on clinicaltrial.gov, NCT05851781-30/04/2023.