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There is a wide array of options for migraine prophylaxis; many of the available drugs are clearly proven to be effective and yet are underused in Australia. “New” drugs which are gaining favour for migraine prophylaxis include topiramate, candesartan, gabapentin and botulinum toxin. In 1996, Mathew and Lucker reported results of an open-label study that demonstrated reduced severity and frequency of headaches in patients with migraine (with and without aura) after treatment with gabapentin at 900 to 1800 mg/day. 5 This study provided the basis for further evaluation of gabapentin in migraine prophylaxis. The results of a Gabapentin shows to have an effective therapeutic action in the prophylactic treatment of migraine. Our observations indicate that gabapentin is well tolerated by patients and that reduces headache frequency and use of symptomatic drugs in both groups. Objective While there are several trials that support the efficacy of various drugs for migraine prophylaxis against placebo, there is limited evidence addressing the comparative safety and efficacy of these drugs. We conducted a systematic review and network meta-analysis to facilitate comparison between drugs for migraine prophylaxis. Methods We searched MEDLINE, EMBASE, CENTRAL, and The pooled evidence derived from trials of gabapentin suggests that it is not efficacious for the prophylaxis of episodic migraine in adults. Since adverse events were common among the gabapentin-treated patients, it is advocated that gabapentin should not be used in routine clinical practice. The objective of our study was to assess the efficacy and safety of gabapentin in the prophylaxis of migraine in patients refractory to other prophylactic treatments. The study included 67 migraine patients, 55 women and 12 men; 52 patients completed this prospective, open-label study. There is a wide array of options for migraine prophylaxis; many of the available drugs are clearly proven to be effective and yet are underused in Australia. “New” drugs which are gaining favour for migraine prophylaxis include topiramate, candesartan, gabapentin and botulinum toxin. Gabapentin is not a first-line drug for treating migraine, so your provider won’t prescribe it to you unless you’ve tried other preventive medications like antidepressants, beta-blockers, and/or migraine-specific preventative drugs that block calcitonin gene-related peptide (CGRP), including Aimovig, Ajovy, Vyepti, Nurtec, Qulipta, and Does gabapentin (Neurontin) help prevent episodic migraine? Evidence-Based Answer Gabapentin does not decrease the frequency of migraine headaches and is not recommended for prophylactic therapy. Gabapentin Gabapentin’s mode of action in migraine is unclear (66). It interacts with the α 2δ-subunit of the calcium channel and increases the concentration and probably the syn-thesis of brain γ-aminobutyric acid (GABA). Gabapentin binds to gabapentin-binding protein—a novel, membrane-associated protein in the outer layers of the Petasites is established to be effective in migraine prevention. 64, 65 CoQ10 is possibly effective for migraine prevention, 27 while riboflavin is probably effective. 66 Percutaneous estradiol is possibly effective for migraine prevention, 67 as is a combination of soy isoflavones (60 mg), dong quai (100 mg), and black cohosh (50 mg). 67 Also, gabapentin reduced the headache frequency by 50% or greater in 45% patients compared with only 16% patients on placebo. Randomized, double-blind, placebo-controlled clinical study 10 of gabapentin enacarbil for migraine prophylaxis concluded that gabapentin was not significantly superior to placebo for migraine prophylaxis. Medications such as amitriptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy. There is limited evidence for nebivolol, bisoprolol, pindolol, significant effect of gabapentin compared with placebo for migraine prophylaxis. In comparison with other widely used migraine preventive drugs, the estimated effect size for gabapentin not only fails to reach statistical significance, but also has a much lower magnitude of effect. The recommendations on what information and self-care advice should be given to people with migraine are based on clinical guidelines National headache management system for adults [], Headaches in over 12s: diagnosis and management [], Primary care management of headache in adults [Becker, 2015] and Pharmacological management of migraine [], the American Headache Society updated consensus Prophylactic migraine treatment should be considered in patients with more than three monthly episodes or at least eight headache days in one month. [4] [5] Patients with severe debilitating headaches despite appropriate acute treatment or those who are intolerant or have contraindications to acute therapy. Gabapentin is an effective prophylactic agent for patients with migraine. In addition, gabapentin appears generally well tolerated with mild to moderate somnolence and dizziness. To describe and assess the evidence from controlled trials on the efficacy and tolerability of gabapentin/gabapentin enacarbil or pregabalin for preventing migraine attacks in adult patients with episodic migraine. The effect of gabapentin to increase GABA concentrations in the brain may provide a possible explanation for its mechanism of action in migraine prophylaxis. Increases in GABA may suppress the abnormal cortical activities that underlie migraine aura and reduce central neuronal hyperexcitability. Objective.—To compare gabapentin with placebo for use as a prophylactic agent in patients with migraine (with or without aura). Study Design and Treatment.—After screening, a 4-week, single-blind, placebo baseline period was followed by a 12-week, double-blind, treatment period.
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